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INDIAN SOCIETY OF HEALTH ADMINISTRATORS (ISHA
104 (15/37), CAMBRIDGE ROAD CROSS, ULSOOR, BANGALORE-560 008
CABLE: HEALTHADMN
® 574297/531979
Fax INLAND :
FOREIGN :
0812-261468 ICFAX-569
] Telex: 0845/2696
or 8055/ICTP/i071
0091 -812-261468 ICFAX-569
BACKGROUND MATERIAL
STRENGTHENING THE CAPABILITIES OF VOLUNTARY AGENCIES
WORKING IN HEALTH AND FAMILY WELFARE
WORKSHOP ON
INVOLVEMENT OF VOLUNTARY ORGANIZATIONS
IN HEALTH AND FAMILY WELFARE
MAY 2 5
27 , 1992
FOR
MINISTRY OF HEALTH AND FAMILY WELFARE
GOVERNMENT OF INDIA
NEW DELHI
WITH THE FINANCIAL ASSISTANCE OF
UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT
NEW DELHI
'--•-mi-tv HEALTH CFII
ISHA
CONTENTS
1.
11.
111.
IV.
V.
VI .
Vll .
VIII.
Objectives of the Workshop
May 25-27,1992.
1-2
Record Note of Discussions of the
Meeting of Voluntary organizetions/NGOs
held on 31-10-1991 in Nirman Bhavan.New Delhi
3-5
Note on the Involvement of voluntary
organizations in the Family Welfare
Programme
Goa-October 3-4, 1991.
7-19
Report on National Workshop on
Role of voluntary organizations in
Health Care Delivery
New Delhi - January 4-5,1988.
20-35
National Conference of Voluntary
Organizations on Family Welfare
New Delhi - September 25,1986.
36-51
Guidelines for Financial Assistance
under Rolling Fund (Mother Unit) Scheme.
62-63
Perspectives, objectivses and operational
details of the NGO Schemes and Areas
Needing Attention of Nodal O'
''ers.
64-86
Action Plan for Revamping the
Family Welfare Programme in 1
87-97
4
a.
I-
ISHA
Workshop on Involvement of Voluntary Organizations
in Health and Family Welfare
May 25-27, 1992
11 is proposed to hold a workshop of three days' duration
on 25th to 27th May, 1992 at Bangalore for
f or the officals at
a t the
policy levels in the state governments as well as nodal officers
of states and certain NGOs.
The participants will come f rom
the States of Karnataka, Kerala, Andhra Pradesh and
TamiInadu.
The broad objectives of the workshop will be
1. To achieve involvement of more and more NGO organizations
in the implementation of the family welfare programme.
2. To
ensure bet ter cooperation between state government
of f icals and the NGOs and to bring about necessary
a11 i tudenal changes to seek increased involvement of
the voluntary sector in the family welfare programme.
3. To
acquaint
the participants with
the polices and
wi th
programme followed at national level for achieving better
implementation of the family welfare programme through
voluntary organizations.
4. To discuss annual action plans of
the state governments
for the family welfare programme to be implemented.
5. To develop appropriate monitoring and evaluation mechanisms
to ensure proper implementation of such projects through
voluntary organizations.
6. To
share
the
experience of the state governments i n
the
implementation of the family
welfare programme
through voluntary organizations in those states fobringing about further improvement.
ISHA
The broad topics proposed to be discussed are as follows:-
1.
Methodology and schemes in existence.
2.
Implementation of
family welfare programme by states and
the experience of State Family Welfare Secretaries.
3.
Action Plan of States for 1992-93.
4.
Better cooperation between NGOs and government officials.
5.
Further possible simplification of procedures.
6.
Problems of NGOs vis-a-vis the community.
7.
Evaluation and accountability of voluntary organizations.
8.
Training needs of NGOs.
f
3
J-L'-Record note of discussions of the meeting of
Voluntary Organisations/NGOs held on
31-10-1991 in Nirman Bhawan,
New Delhi.
A /neeting to discuss policy pertaining to involvement of
Voluntary Organisations/NGOs in the F•Programme was hela in the
Ministry on 31-10-1991 under the chairmanship of Shri K K Uathur,
Secretary (FM). The list of participants is at annexure.
The main purpose of the meeting was to discuss the involvement
of the Voluntary Organisations/NGOs for the promotion of F.V* programme
in the country in the light of various discussions held in the five
regional conferences at various places. A number of organisations
who have been associating themselves with various schemes tn this
Ministry had been identified and requested to participate in the
meeting. In addition, a number of international donor agencies who
have been showing keen interest in the furtherence of the F.W.
Programme especially through voluntary organisations/NGOs were also
invited.
A brief background paper which incorporated the current thinking
in this regard as also the salient points which emerged in the
regional conferences was circulated in the meeting.
Welcoming the participants, Mrs. Rita Menon, Director (Media)
regretted the short notice given to the partici pants and thanked them
for attending the meeting which was indie at ive of the inter est and
concern they have been showing towards this very important national
programme. Director (M) highlighted the various steps Government
have taken to stimulate participation of voluntary agencies in the
Family Welfare Programme and measures taken to reduce the time taken
tn processing of cases etc. She briefly, mentioned about the current
thinking to set—up an Apex body tn the field of Voluntary Organisations/
NGOs which could take up the work relating to coordination, sanctioning,
monitoring, evaluation etc. of F.W. Programme tn their respective areas.
Smt. Suneeta Mukherjee, Joint Secretary in her inaugural discussion
gave the background of the apex body intended, as well as an insight
into the Government policies relating to funding of Voluntary agencies
and laid special emphasis on the funds placed at the disposal of
State Governments for training, visits and interactions amongst
voluntary agencies. She also announced that Prof. Sontoso had been
invited to make a presentation on the F.W. Programme in Indonesia and
the role of Government and Non—Government Sectors therein. As is wellknown, the concept of community participation has been most fruitfully
translated in action in Indonesia.
Shri K K Mathur, Secretary (FW) in his key note address expressed
his happiness that representatives of various organisations have come
for this very important meeting at such a short notice. He specifically
mentioned the benefits of availing of the opportunity of inter act ion
with Dr Sontoso after his presentation on Community Participation in
z/.
2
Indonesia and how far this could be practised in our country. He
also mentioned the imperative need for finalisation of well-devised
strategies to bring dynamism in the F.W. Programme through Voluntary
Organisations/NGOs. He reiterated the government9s contention to
make F.W. Programmes a People9 s Movement. For this, participation and
cooperation of the voluntary organisations/NGOs was considered to be
very essential particularly due to the fact that these organisations are
so much a part and parcel of the community itself. The Government on
their part have introduced many schemes and are providing services
through the Primary Health Centres etc. However, it is an established
fact that considerable gaps still remain to be filled and herein comes
the importance of Voluntary Organisations/NGOs. It needs to be borne
in mind that the efforts made by NGOs/Voluntary Organisations are to
be taken as vital and crucially supplemental to Governmental efforts.
Secretary (FW) mentioned about the meeting of State Secretaries
incharge of Family Welfare held towards the end of August, 1991. It
was observed therein that many of the States did not have clear
perception as to the role which could be fruitfully played by NGOs/
Voluntary Organisations in furtherance of the Government programmes.
Referring to the field of communication, Secretary(FW) stressed
that 1HC activities need to be considerably strengthened at the local
level and interface with other activities improved. Our endeavour
should be to cover the total population in the field of education,
motivation etc. For this also, the effective role of NGOs/Voluntary
Organisations was highlighted. Secretary (FW) also mentioned mis
conceptions of the people about Family Planning Education. He desired
that we should take up programmes through focus of media which would be
accepted by the people.
While congratulating the Voluntary Organisations\NGOs for the
good work already being done by them. Secretary (FW) specially mentioned
that there existed many smaller organisations which are also really
keen to contribute in F.W. Programme in the country. These smaller
organisations have certain inherent problems, namely, lack of knowledge
about project formulation, existing government schemes, rules.
procedures etc. He was of the view that the role of bigger voluntary
organisations in educating and assisting their smaller coyjite'¥PaT'ts
in this area was of vital importance to the programme, This way there
can be more coverage by voluntary organisat ions/NGOs. This aspect was
considered to be a very vital by all present and clear policy in this
regard needs to be enunciated.
Secretary (FW) elaborated the current thinking about setting up
of an apex body which will be outside Government and will look into
all the demands and sanctions for voluntary agencies and NGOs. A
final pr ictur e would emerge after getting a feed-back from participants.
The participants were requested to give their views. Secretary (FW)
hoped that with active co-operation/involvements of voluntary/NGOs
Sector, it would be possible to push ahead the family welfare programme
in the country, bringing down the growth raze and creating an atmosphere
of meaningful socio-economic development in the country.
j
5
Representatives of different voluntary agencies gave various
reactions, suggestions to the agenda points and key note address of
Secretary (FWJ. Shri Bunker Roy of Tilonia (Rajasthan) wanted family
welfare programmes to be integrated with other rural programmes for
action like drinking water, self-employment schemes, rural technology
and education. He expressed reservations about state-level committees
for assistance to voluntary agencies and stated that certain voluntary
agencies could be earmarked for undertaking training of both other
agencies as well as schemes implementing personnel in government.
Mrs, Wadia of FPAI expressed her request that a responsible
feedback for the voluntary sector must be recleared when deciding
further government policy on the voluntary sector and there was a
need for a Population Commis si on to enable deliberation at the
appropriate level.
Mr Srinivasan expressed a view that forming SCOVA's at state
level was a more good decision to enable action at the final level
calling for involvement of state government level officers.
Various participants then gave their views on the proposal
to set the Apex body. A number of procedural changes were also
suggested. It was also stressed that Government should ser iously
and positively think about more direct advertisements through Press/
Radio/Televis ion etc.
Another point made was regarding disparities tn payscale of
workers of voluntary organisations and government employees• It was
however, earlier clarified that one of the important plans of the
voluntary movement was their credibility and closeness to people at
the grassroot. In other countries voluntary organisations function
with a considerable level of independence.
Secretary (FW), suggested the formation of a group of three
members from out of the participants to decide about objective,
flexibility, financial aspects, proper utilisation of funds, etc.,
in a very simple terms and keeping in view the requirements of
accountability. The three member group could prepare two or three
model schemes at an early date. It was decided that Shri. Soy,
Shri Srinivasan and Shri Kulnarani coula form the group.
The afternoon session started with a presentation on the
family planning movement in Indonesia by Dr Santoso. Various components,
of the family planning programme in the country, commitment of the
Government at the top-most level and full-/1 edged participation of
the community were highlighted in detail in the presentation.
Concluding the deliberations. Joint Secretary (M) summarised the
various points which emerged during the discussions, particularly in
regard to the formation of the Apex^body.
4
The following points emerged with reference
for setting up of the Apex-body.
to the proposal
VOLUNTARY ACTION FOR FAMILY VRT.FARS AND HEALTH-
(VAFA1I )
Governing Council
to be involved.
Majority for the Voluntary Sector
be rural-based.
Voluntary Sectors should
<
Should be action-oriented.
involved) with grassroot
A gender thrust (with more women
experience may be stressed.
intra-jurisdiction aspect are desirable.
Regional Centres -
EXECUTIVE BOARD
Chief Executive on contract (5years).
*
Highlight aspects of Health and Family Welfare.
- Water, employment. Integrated Programme
Other concerned areas Welfare activities.
to be integrated with•. Family
F
*
*
Answer able to highest authority.
*
Coordination with Ministries, technical experts,
should be built-in.
institutions
Should be non-party political.
o/ conduct to be drafted by the Oryanteatton.
Saaluatton and deliboratton or awarding of grants of old sohewes
*
may be included in the brief.
rPICH ARE TO BE DECIDED ARE AS FOLLOWSISSUES
VAFAH Constituion.
of populati on
♦
Changing attitudes-Long term lEC-total coverage
♦
Tand
hreeShri Kulkarni to formulate a wfew
fl model schemes
Government within a month.
Sustainability part to be given priority.
strengthened further,
Mother Units concept to be developed and
Accountability (Financial) will have to be basic.
Conduct/ethics have to be developed.
to the chair.
The meeting ended with a vote of thanks
7‘
— NOTE ON THE INVOLVEMENT OF VOLUNTARY ORGANISATIONS
IN THE FAMILY WELFARE PROGRAMME
In it Iva t Ives
Gove mmen t
The
National
Family
family planning as a
Voluntary
Programme
people’s
Organ!sa tions
has been
Welfare Programme seeks
movement.
the
recognised and gi ven
the programme.
In a
change
and
attitudes.
social
behaviour.
personal
the ability of Voluntary
attitudinal
at
changes
the
role
Fa mily
importance
very ineepti on o f
in
vital
The
promo ting
in
to promote
of
Welfare
from
the
programme calling for
per ceptions
Organisations
grass-root
level
to
is
and
effect
generally
expected to be more effect! ve than from Government.
There are
Voluntary
many
Government
organisations
Fa mi 1y
Iv e 1 f a r e
schemes
f or
for
Programme.
financial
schemes
for
grant-in-aid
the
purposes
The
following
are
unde r
Central
assistance
of
the
to
implemen ting
the
main
Sector
Scheme;
1.
1nnovative and Experimental Schemes.
2.
Ijini
3.
Project Linked Model Schemes.
6.
Private Voluntary Organisations for Health
family Welfare Scheme.
(PVOH)
Schemes•
5. Rolling
fund schemes through Mother Units.
Results so far
Hot-withstanding
the
facilities
initivatives
provided
for
taken
p romotion
oi
by
government
and
o1
the
activity
..az
-2vol un ta ry
sector
under
voluntary
sector
activity
1
funds
I
appears
be
provided
that
fully
remain
the
above
is
menti oned
no t
realised.
the
-and
the
extent.
1t
fully
optimised
to
1 a rge
unutilised
the potential
s eheme s,
a
of the voluntary sector is yet to
The
following
bottlenecks
are
encountered:
1.
Organisations (NGOs) often pe rce ive
Governmental procedures as slow and cumbersome.
2.
NGOs
Non-Governmentai
are
not
aware
adequately
financial
the
of
assistance being provided by the Government of India
under various schemes.
3.
Grass~root
unable
1 evel
to
workers
utilise
are
not
the
a ware
of,'
financial
or
are
facilities
available.
4.
It
has
been
felt
do
not
know
how
that
to
s ome
voluntary organisations
formulate
or
undertake
providing
financial
schemes
its financial management or monitoring.
5e
The
existing
schemes
for
assistance are limited.
Efforts taken by Government
to boost
the activity of
Voluntary Sector
Gove rnment
encourage
has
1 ar ger
t aken
the
partici pa ti on
following
initiatlves
to
of
involvement
of
and
Voluntary Sector for Family Welfare Programmes:
i)
bide publicity has been given
avail able
in
the
for
field
advertisements
a ssistance
of
Heal th
to
to
Gove rnment
Schemes
Voluntary organisations
and
Fami1y
Eel fare
by
through television and the Press,
. .3/-
I
-3-
State
ii)
Level
Agencies
Standi ng
(SCOVA)
Gover nment
Committee
Committees
officials.
of
Heal th
of
State
representatives
of
the
const!tuted.
welfare
from
Centre
to
the
voluntary
also
and
in
NG Os
for
It
been
has
are
Welfare
project
proposed
sector
impart
the
to
for
funding
necessary
training
formulation
management with technical
Hi)
of
This Committee will recommend projects
in family
the
representative
Fa mi 1y
a nd
Voluntary
comprising
voluntary organisations and a
Ministry
ot
and
financial
and monitoring sup port.( Annex. I)
that
adequate training should
be organised for the voluntary sector in each State,
atleast in
two
places
sector
one
in
the non-governmental sector.
be
in
and
training
will
techniques,'
we 11
as
onC within
the
areas
contraception.
of
aspects
the
of
Governmental
HCH,'
steri1i sa ti on
information,!
The
Spacing
etc,,-
education
as
and
commun1catioer and above necessary training ibdluz. v—
a) Project Management.
b) Financial Management.
c) Project Monitoring & Evaluation.
iv)
It
has
also
been
proposed
workshop^seminars/meetings/study
to
tours
of
hold
the
voluntary sector for sharing experience and ensuring
inter-action
between
in
Indi a
overseas.
the
organ!sa tions
and
difficulties
in
in
the
various organisations both
Study
tour
for
workers
of
the States which may have some
running
projects
or
who
want
to
Id-4-
• effect
further professionalism in their activities^
may be organised to States where work
is
being
done
in
the
by NG Os at a sufficiently good level.
v)
Nodal
Officers
have
been
notified
States/Union Territories to facilitate speedy action
on
the
proposals
financial
<
vi)
of
voluntary
assistance •
A
organisations
for
list of the Nodal Officers
is enclosed at Annexure-II.
It
1s
also
proposed
to
community based model
the
smaller
the
1 n vol vemen t
develop
schemes
a
set
of
Zilla
new
to involve effectively
organisations.
voluntary
cf
Schemes
Parishadj
wi th
Panchayats^
Municipal Authorities and private practitioners have
been proposed and are under process.
vii)
It
has
been
Voluntary
Association
A
to
prepare
Organisations
co-ordination
Job.
decided
to
and Information.
of
India,'
grant-in-aid
Bombay
a
Directory
ensure
of
better
The Family Planning
has
to
undertake
the
has been sanctioned to them to
prepare a Directory on Al1-India-level.
viii)
already produced the first
They have infact
volume of the directory.
It
to
also
has
viz .
proposed
set
up
an
Apex
Body
Society for Voluntary Action for Family Welfare
and Health
Apart
been
from
(VAFAH)
to administer'2
Government
of
Indi a
agencies of the United Nations and
expected
tn
hplp
fund
it.
It ■ 9
grants/^o^NG^s^hS
funds,'
External
bodies
are
expected that
the
other
'll.
setting.
up
Apex
sn
const 1tute
This
avail able.
such
VAFAH
«5
voul d
in the movement, looking at
see-chenge
end
eutonomy
would
a ark
flexibility
the
Body
thet
wa ter shed
a
be
would
in
the
voluntary sector movenent and would go a long way in
achieving
goal
the
making
of
family
welfare
a
This proposal is presently under
people's ooverrent.
active consideration.
through
ix) Lecentrali sation of grant-in-aid procedures
setting up of rolling funds for involverr.ent of sra 11
voluntary organisationsA
rolling
fund
disposal
India,
of
the
of
lakhs
t.5
the
Association
of
Planning
Far.i ly
t o s in a 1 1
to give financial assistance
Eonbay,
organ!sat ions
volunta ry
hac been placed at
for
upto
schemes
E. 1
lakh
The Family Planning Association of India
per annum.
f
has also been given financial assistance for setting
up a Consultancy Unit at its Head-quarters at
to
provide
for
formulating
the
Uni t
30
small
Concept
current
been
viz.
CIEAR,
CIPI,
build
up
to
of
Covernment
any
of
India
spread
organisat ion.
India
is
to
has
The Pother
to
network
various parts of the country before
project
scheme,
4
other
CERPA *
and GIRHFVI/during
a
project-funding
decentralised
of
extended
has
year
this
organisations so far.
Scheme
organisations
the
Association
a gencies
other
Under
projects.
Planning
Family
approved
such
to
services
consultancy
Bombay
be
system
across
approve 1
of
oi
the
the
approval
of
the
obtained
by
the
mother-unit.
...6/.
i a.x)
To involve ~ore and more organisations in th.e family
Welfare
Prciranne
schemes
i:r
meaninqful
to
financial
exchange
1991,
the
Madras,
assistance
of
views.
the
these
had
were
held
Shimla
and
Goa
be tween
the
Conferences/meetings
Annexu re-111.
Patna,
and
participated
and
The main points
working
are
Action has already
at
1SSO
been encouraging.
of
a
Regional
NGOs
recommendations
for
and
f i ve
where a large number of NGOs
response
Go vq mocn t.
of
Conferences/meetings
Calcutta,
wi t.2
then
acquaint
been
groups
of
enclosed
at
processed
or
most of the recommendations.
Issues
i)
to be decided
Improving
the
organisetions
skill
and
and
their
motivat ion
workers
of
voluntary
through
training.
greater interaction, conferences,' and workshops.
ii)
Object
of
towards
family
changing
the
community
programme
through
voluntary
voluntary
sector
the
welfare
attitude
of
sector.
Hi)
Sustainability
of
the
over
the
long-term.
iv)
Extension of mother-unit concept to cover more grass
root level organisations.
...7/-
13:
v) Community Participation in
t •] ‘2
J vi) Accountability of the Voluntary
pro<jrar-r.ie .
Sector
ana
capad ty
to stanc up to financial scrutiny.
Ab 11i ty
spin-off
of the Voluntary Sector to promote adequate
effects
of
welfare
activi ties
in
the
regions where they operate.
* ** ** *
**»»
*»
CLEAR
( Centre for Labour Education and Social
Research Unit J
CINI
( Child In Need Institute )
GIRHFWI ( CandhiQlram Institute of Rural Health
and
Famil^ffelfare )
CERPA
( Centre for Research, Planning and Action )
STATE LEVEL COMMITTEE
1.
LevelI tCcmmittae is to be sot up:• i cr clearing
/I State Lave
the* Projects ooli voluntary organisations one
.
zo guide
them in project formulation.
The composition and t er ms
of reference of the proposed commi tee have also been
suggestec t o the State Governments/Un ion Territories.
2.
i! GO would be
set
up
for
An apex level NGO
ano
technical
support
to
NGOs
training
Project formulation and monitoring systems.
3.
The State Gov eminent s/Union Territories should submit
their recommendations/comments on the proposals of NGOs
within a period of 12 weeks on a reference received
from
the
Central
Government.
If
no
reference
is
received during this period, it would be presumed that
the State Government/Union Territory has recommended
the Project.
4.
Number of instalments for release of <grants has
reduced to 1 for the projects upto is. 1I lakh and
for Projects exceeding Es. 1 lakh.
5.
functioning
for
eligibility
The
period
of
for
grant-in-aid and of a minimum 3 years experience for an
NGO seeking grant-in-aid has been revised as
gi ven
below:
providing
regarding
been
to 2
For Projects for E.
5 lakhs & above
3 years
For Projects for
1 lakh & above but
2 years
below Its. 3 lakhs
(
Below Us.
1 lakh
1 year
' ir.
i
J
ex /Gram
ti
(
1 -
r. uJe n C::an -r2 Das,
Asstc. Director h331th
S«? v v i c e s s
Government cf Tricura,
Health
Family Welfare
Deoartmen t,
^AG AT J a LA (TR I PUR A) .
2.
Dr. D^ya Shankar,
O.int u ir sc ter (urban),
Family Ualfare Diractorata
Government of Uttar Pradesh,
LUCKMC'J (UTThR PRAOtSH).
3.
Chief Medical Officer (FJ) ,
Delhi Administration-0elhi,
5, Sham Nath Marg,
Delhi -1 10 054,
4.
Dr, Y.S. Sadananda Singh,
State Family Welfare Officer,
Government of Manipur,
Secretariat; Health Department,
MANIPUR*
5<
Shri Kuldip Kumar,
Director Health Services
Government of Haryana,
CHANDIGARH.
(FW),
6a
Dro(Mrs.) Harbir Bajwa,
District Family Welfare Officer,
U.K OF CHANDIGARH*
7.
Dr. V. RUGMINI,
Addl. Dir. of Health Services
Government of Kerala,
Thiruvananthapuram (Kerala)€
fie
Smt* Girija vaidyanathan,
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Collector,
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Dr. R.A. Siddiqui,
Director,
public Health & FU Deott.,
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Dr. Prakash B. Nadkarni,
& ncH),
Thief Medical Officer (
sK' Knlly Welfare Bureau,
Campalt Panaji,
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.Assistant Secretary
'• De :'rti.iunt if Health
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* Calcutta -.1.2^.
Shri P.fi. Rarr.anathan,
Health Sacrotary,
Gavt. of Pondicherry,
Pondicherry.
9
(Annexe)
:
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•;-r iclul office
-:.
S Add repp
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Dra C.r;. han a,
CFO , ejvt. Hospital Daman,
Daman '< Diu Administration,
Damar..
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Shri 'firn.
rJ’.pne N a.
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Health Secretary,
Govt, of Rajasthan,
^4 "Y V iC-^—
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Shri
lanir.
Health Secretary,
Govt, of Nagaland,
26.
Shri H.U. Lairinga,
Health Secretary,
Govt, of riizoram,
pizaulc
27.
6hri G.P. ix/ahlamg,
Health Secretary,
Govt, of f'ieghlaya,
28.
Shri H. LZ
z Kadalbiju,
Kadalbiju,
Health Secretary,
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’
Govt,
of 3 a nun u '& Kashmir.
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Smt. L'. Shenoy,
Secretary ( FL/j ,
Govt* of Gujrat,
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Govt, of Bihar,
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Gt'ner. important recommendations of the L'orkinc Group at
Regional ileeting of Voluntary Sector at Goa held cn
and 6th October,
the
the 3rd
1031
a)
echoes should be stressec upon
3 j d c i r. •
to the . ermanent (sterilisation) methods.
b)
Programmes
connunity.
c)
NGO's Projects may be considerec to implement some o i
the Income Generating Schemes for project areas.
d)
NGO's may be made depot holcers for distribution of OPS
and safe disposal kits.
e)
To oevelop an effective reference system NGOs should
share the responsibility and they should coordinate the
community and health workers.
1)
i.GOs should be taken into confidence
and
actively
involved in action planning and policy matters.
should
be
bases
on
fel t
n sees
the
oi
by
Consultancy
services
for
smaller
organisations
competent bodies should be provided i.e. Government can
use NGO's channel to approach the grass root level.
(
cl ear
h)
NGO's should also have accountability and
records for sanction of grant and schenes.
i)
Criteria for release of grants and
change
Family Planning Schemes need
criteria for monitoring.
j)
Follow-up should be done when time bound schemes
over so that they are sustained further some way.
keep
continuetion
of
targets
of
or
are
So-
Report on
National Workshop on
Role of Voluntary Organisations
in Health Care Delivery
New Delhi: January 4-5, 1988
DIRECTORATE-GENERAL OF HEALTH SERVICES
Ministry of Health and Family Welfare
Government of India
Nirman Bhavan, New Delhi: 110 011
and
THE VOLUNTARY HEALTH ASSOCIATION OF INDIA
40 Institutional Area, (behind Qutub Hotel)
New Delhi: 110 016
a.|.
FOREWORD
The National Workshop on the Role of Voluntary Organisations in Health Care Delivery
was organised in January, 1988. The co-operation of voluntary agencies with government
organisations to achieve Health For All (HFA) by 2000 A.D. has to be stepped up to ensure
and enlarge the scope of community participation. This is an area where voluntary
organisations have shown considerable enthusiasm with their motivation and personalised
approach. National Health Policy of 1983 by the Government has also emphasised the
importance of involving voluntary organisations in health care delivery
This workshop was convened in order to make best use of the natural strength of
voluntary sector in the delivery of health services. Besides, Workshop emphasised the
ways and means to promote full participation of the Govt, with the voluntary sector in
health care delivery.
RAM NIWAS MIRDHA
MINISTER, HEALTH & FAMILY WELFARE
GOVT OF INDIA
COI^H zoo
COMMUNITY HEALTH CELL
326. V Malo, I Block
Koramangala
Bangalore-560034
India
BACKGROUND
In India, voluntary organisations have a long tradition of providing health care. Voluntary
organisations have many positive aspects: rhey are close to the people, responsive to
their needs, economical, and are able to attune to local conditions quickly and effectively.
Not surprisingly, they are popular and most of the health care services especially in
remote and underserved areas are provided by them.
The government has realised that voluntary organisations are indispensable allies in
the delivery of health care not only because they supplement government resources but
also because there is much to be learnt from their experiences, expertise and innovative
ventures. The government has also realised that to date no systematic efforts have been
made for establishing proper rapport and coordination with voluntary organisations and
evolving processes for effectively integrating their efforts and activities into the national
health care delivery system. This collaboration between government agencies and
voluntary organisations can succeed only if there is open two-way communication. The
need to facilitate such a dialogue between representatives from the voluntary as well as
government sectors and to work out the mechanisms of future collaborative arrangements
between them in the field of health care delivery was also recognised. With this end in
view, a National Workshop on “Role of Voluntary Organisations in Health Care Delivery"
was organised by the Directorate General of Health Services, Government of India, at
Vigyan Bhavan, in New Delhi, on January 4-5, 1988.
OBJECTIVES
The main objectives of the workshop were:
1 To review the roles of various voluntary organisations working in the health
sector engaging in alleviating human suffering and promoting health and quality of life.
2. To identify the priority areas of voluntary participants in the context of health
for all by 2000 A.D. and
3. To work out a tentative programme of voluntary participation indicating its
nature, thrust areas, role of government agencies in supporting such participation etc.
PARTICIPANTS
The participants of the workshop were drawn from those voluntary and government
sectors which are engaged in the field of heahhcare delivery. Also included among the
participants were health administrators, policy planners and representatives from
international organisations. (A list of the participants and their addresses is given in
Annexure I).
The workshop was organised by Dr. S.C. Sharma, Asst. Director-General of Health
Services, (Health Administration), on behalf of the Director-General of Health Services,
as the organising secretary of the workshop.
3
INAUGURAL SESSION
The workshop was inaugurated by Shri P.V. Narasimha Rao, Union Minister of Human
Resource Development and Health and Family Welfare. Dr. G. K. Vishwakarma,
Director-General of Health Services, Government of India, welcomed the Chief Guest
and the participants. In his welcome address, Dr Vishwakarma gave a brief overview of
the present health care system in India. He described the problems in the existing health
care del ivery system and reiterated that voluntary organisations can play a very important
and a significant role in evolving suitable strategies in this area. He referred to the
government sector and the voluntary sector as two important pillars on which the entire
health care delivery system in India depends. Introducing the theme of the workshop,
Dr Vishwakarma raised certain vital issues pertaining to (a) identification of areas of
collaboration and cooperation among government agencies and organisations working
in the voluntary sector in the health field (b) need for evolving appropriate mechanisms
for future collaborative arrangements between them and (c) areas which need priority
attention in the field of health care delivery, to be examined in the deliberations of the
workshop.
Shri S.S. Dhanoa, Secretary, Ministry of Health and Family Welfare, in his key-note
address stated that voluntary agencies have a great tradition of providing health care
services and are doing pioneering work in the health field. He also pointed out that the
voluntary sector is fulfilling an important role in health care. He stressed the need for
encouraging them as they elicit greater people’s participation. He then drew attention
to a number of well-known health agencies from the voluntary sector viz., Indian Red
Cross Society, Hind Kusht Nivaran Sangh, Family Planning Association of India, Bharat
Sevak Samaj, etc. which have made many contributions in the health field and are
providing health care services to the people in different ways. He then dwelt on the
type of services rendered by the voluntary organisations in the field of health viz., (a)
advancing health legislation, (b) health education, (c) supplementing work of
official/goverment agencies, (d) demonstration/experimentation, and (e) pioneering
efforts/innovations. He stated that sincere efforts must be made to understand the
message that lack of health education and awareness in our country gets further
accentuated due to illiteracy, particularly in the remote rural and tribal areas. Shri Dhanoa
reiterated that this is where the role of voluntary agencies becomes crucial for the success
of various health and family welfare programmes. He also stressed the need for the
voluntary organisations to share the growing burden of the government in efficient
implementation of health care programmes. Shri Dhanoa concluded his key-note address
by saying “There is no denying the fact that medicine is not entirely an academic, physical
or biological science but is intimately related to sociology, economics and indeed
pol itics and in our set-up, the existence and vital role of voluntary health agencies cannot
be disputed”.
Inaugurating the workshop, the Hon'ble Minister, Shri P.V. Narsimha Rao said:
“I welcome you all to the first ever workshop, and I stress the word workshop',
organised in the health care sector which I have the honour to inaugurate. I am stressing
4
I
the word workshop because we have any number of seminars, we have any number of
meetings and so on where excellent ideas and advice, would come, but a workshop,
I believe, is a basically different thing The activity here has to be entirely different and
the results which one could expect from such a workshop would naturally be different
While a seminar could be concentrated on a consensus of ideas and work, the workshop
would bring out a concrete programme, ready in all respects to identify problems of
health care and to be put into action with immediate effect. This is the difference and
if this difference is appreciated I am sure you will not spend much time on the inauguration
ceremony. You have very little time and the field is so vast. I am not sure you will be
able to cover the whole of it. You have to spend usefully, every minute that is available
to you and your practical experience in the field has to be brought to bear upon the
subject which you are discussing.
We have heard of many voluntary organisations taking up family welfare programmes
In fact, they have played a pioneering role. However, the concept of family welfare has
over the years undergone a change. It is not just a matter of asking the couple to adopt
a family planning method and so on but it has to become a part of the larger and much
more important subject of health of the people itself. So from that point of view the
question which you will have to ask is whether the organisations which are engaged in
family welfare programmes at the moment are in a position to extend their activity so
as to take on the work entailing a wider concept of health of which family welfare is a pan
The second question is how you will get involved in implementing health care
delivery programmes because so far the main components of health care were of only
two or three kinds and mostly provided by the Government. We have the system of
hospitals, we also have the institutions, mainly operated by the Central Government ano
State Governments at various levels. This has been the pattern so far. Now if I do know
the objective of this workshop correctly and if I do know the work also correctly I must
say our roles have to be reversed. It is not easy to reverse the roles. It is observed that
the non-government organisations have been doing good work in their own limited
sphere which has gone to help the efforts of the Government. Thus, the Government
happens to be the main doer at the moment. Now government would have to take a
different role and so we help you in doing it and you make it your own programme. Is
it practicable for you? I am very clear in my mind that if this is possible it is very desirable
that it should be done. We have not been able to do it to our satisfaction, in this
meaningful form before, but we should think of doing this. I am sure you will give ideas
and a concrete Plan of action.
I would say there are three kinds of programmes. First the institutional programme,
even voluntary organisations have been doing these; they have been running hospitals
they have been running dispensaries, they have been holding Eye Camps and all kinds
of programmes, programmes of an institutional or semi-institutional nature. The second
kind is the promotional programme. Now, a promotional programme is both easy and
difficult. The question is : how do you promote a programme, the basis on which to
administer the programme etc. Promotional programmes by themselves will not make
5
SIS'
an impact unless they are buttressed and followed by actual activities suggested in the
programmes. The third is the educational programmes. There is a difference between
them. We in the Educational Department, the NCERT and other institutions including the
State Governments have now taken up a massive reorganisation of books and curricula.
I have been insisting that the health component should figure in a big way there. It is
indeed very important that a child knows how to safeguard his health; care of the eyes,
care of the ears, care of the teeth, and so on. We had such lessons 50 years ago but it
has to be done in a different way now. The NCERT does it by including in the curricula
the component of environment. How do you deal with population? How do you deal
with small family norms not at a primary stage but in later classes? So these methods
are being looked into very seriously by the NCERT, and the Department of Education
and they are making it a part of the school curricula directly as well as indirectly. It is
not merely a lesson but a very important question on environment. It is not enough that
you include one or two lessons on the subject. It is easier said than done; but we are
tackling that problem. Now it is not under the Health Ministry or the organisations working
in the health field. This is what this School Health Programme for instance is. I have been
Minister for both. So I have taken both these in a very serious manner. And we are
grappling with them for more than a year and now we have been able to find a frame
in which the school health programme can be started and implemented in this country.
If that one subject is fully taken care of, I am sure your programme will become easier.
So too the education and school health programmes — these are a gist of all other
programmes and these programmes are not of just the Health Ministry but also of the
Education Ministry. So the coordination and integration between health and educational
sectors are of the utmost importance. You will like to liaise with schools in those areas,
with students and teachers. Indeed the ICDS programme is again a basic programme. It
is not under the Health Ministry. But it is not enough to say that this is not under the
Health Ministry. So the whole thing becomes one big subject which the Prime Minister
has called Human Resource Development.
4
“Now we have been asked so many questions with regard to smoking. One poster
has come in the newspaper ‘Made for Each Other: Smoking and Death'. It is a very
effective poster. If one poster can move people, how bad smoking is and how cancer
is going to be the result of smoking the same thing can be done by voluntary organisations
in a thousand ways. We do not arrogate ourselves all rights to educate the public. This
is one thing you have to do. The voluntary organisations should say that for the next two
or three years v/e wi 11 take up only education programmes. With the experience available
at the field level if you take up at least education programmes in curricula, it will be
enough. Doordarshan is giving good coverage. The time has come when you have to
diversify the programmes. People do not want to see the same thing again and again.
Now Mrs. Rami Chhabra has raked her mind for this. But somebody must rack his mind
now on the health side on issues such as vaccir^s, immunization programmes etc. For
instance, if voluntary organisations can help us in the implementation of immunization
programmes. If you are a voluntary organisation with few resources, you can go to
government hospitals here and there, they have resources, take the children there. You
deal with children, we deal with adults. I am giving just one example where Government
and voluntary organisations could come together. There need not be a duplication.
6
i
/
Take a block, depending upon the areas where you are functioning, and try to
design location specific and needbased practical action plans of a problem solving
nature. I am not in favour of seminar after seminar, workshop after wort<shop. Let us take
the recommendations emerging out of such workshops and put them in action. If you
give one concrete idea for developing appropriate health care programme in tribal areas,
that alone will do for the present. Tribal areas are the areas where nobody wants to go.
So we should begin earnestly in that area. This is what voluntary organisations can do
without much money because we do not have so much money. Let us not think of
schemes which will immediately cost money. Right now this year and in this Plan, things
are very tight. You give me ideas for the next Plan because the planning, the thinking for
the Eighth Five Year Plan is starting right now. This is the time when you should say if
this programme can betaken in the 8th Plan, it will be very good. Think in terms of what
is immediately convertible into a programme at the field level and what we can do. We
will certainly call a meeting of the State Ministers, our people can go, liaise with the
voluntary organisations in that area. We can get people together and see what can be
done to immediately put it into action. That is the real thrust of the workshop. I will not
take too much of your time. If anything is going to come as a concrete programme, we
would be very happy to put it into action within -the budgetary provision we have.
I am very happy to inaugurate this workshop. I hope we will come out of the
workshop with all the paraphernalia of a 'real workshop', coming outof the workshop,
not going into a workshop coming out of the workshop with oil, grease, etc. I wish your
deliberations all success. Thank you very much.”
Dr A.K.Mukherjee, Additional Director-General of Health Services, proposed a Vote
of Thanks.
After the inauguration, the workshop was conducted in Plenary Sessions as well as
in Working Groups.
PLENARY SESSIONS AND WORKING GROUPS
Plenary Sessions
Three plenary sessions were organised, two sessions on the forenoon of 4th January,
88 and the third session on the forenoon of Sth January, 1988. Each plenary session
was addressed by eminent scientists/experts/workers actively engaged in that specific
field. Each address was followed by discussions and clarifications. The first plenary
session was addressed by Dr Harcharan Singh, Prof. D.Banerjee, Dr Samir Choudhury, Shri
bP.G. Haran and Dr A.K.Mukherjee. The session was presided over by Prof. Ashish Bose.
The second plenary session was presided over by Mr Bunker Roy and was addressed
by Smt Avabai B. Wadia, Shri Alok Mukhapadyay and Shri P.K. Uma Shankar The third
plenary session was addressed by Dr (Mrs) Shanti Ghosh, Prof. B.N.Tandon, Mr Bunker
Roy, Dr Almas All, Dr M.I.D. Sharma and Mrs Rami Chhabra. The session was presided
over by Smt Avabai B Wadia. (See Annexure II for the details of the procedings).
7
Reference Materials
The participants were provided with reference material. Considering the time limitation
m covering the plenary sessions in detail, it was considered important to provide some
relevant reading material (See Annexure III).
Working Groups
•t
After the two plenary sessions of the first day, the participants were di /ided into three
working groups and were assigned the following tasks :
GROUP I: Working Group fordrafting plan ofaction and modalities ofcooperation
between the Voluntary Organisations and the Governmentof India.
,1
(i) To identify priority areas of cooperation for Family Welfare and Primary Health
Care Programmes.
(ii) To identify inputs - materials, rrjanpower, etc; and
(iii) To formulate plan ©faction indicating guidelines, format of proposals, periodic
reporting, nature of feedback etc.
GROUP II: Working Group on training requirements
(i) To identify the topics and areas of training
(ii) To identify trainers/core-faculty from voluntary organisations for various topics
(iii) To specify provisions of Scholarship/Fellowship for training of personnel of
Government and Non-Govemment organisations
(iv) To explore the possibilities of financial assistance to training institutions for
imparting training in specific courses; and
(v) To suggest ways and means of procuring and preparing publications, technical
reference materials, books, manuals etc
GROUP-III: Working Group on administrative matters
(i) To identify and consider administrative problems and make suggestions for
remedial measures
(ii) To indicate norms of grant-in-aid to the voluntary organisations; and
(iii) To work out a uniform service pattern in voluntary organisations with regard to
the Primary Health Care Programme
These three working groups deliberated separately on the afternoon of 4th January
'88 and forenoon of Sth January '88 and drafted reports/recommendations in respect of
the themes mentioned above. Major emphasis was laid on group discussions to thrash
out relevant recommendations about the directions and modalities in which future
relations between the government and voluntary organisations should be developed
Pre-valedictory Session
At the plenary session preceding the valedictory function on January 5,1988, the group
reports along with their recommendations were presented and discussed. This session
was presided over by Smt Avabai B. Wadia.
8
I
V /
a?.
Valedictory Session
t
4
The Valedictory function was held at 4 pm on January 5, 1988 and was presided over
by Prof. S.N. Choudhury. The valedictory address was to have been delivered by Ms
Saroj Khaparde, Minister of State for Health and Family Welfare, Government of India. As
she could not be present, a representative from the Directorate of Health Services,
Government of India, read the address on her behalf. The address, which constituted a
fitting finale to the deliberations of the workshop is as under:
"I would like to express my pleasure in addressing the Workshop On Role of Voluntary
Organisations in the field of Health Care Delivery.
“India is a vast country, and has several distinct diverse geographic zones. Multiple
ethnic groups add to the complicity of the situation. It is perhaps more than a Herculean
task to make available comprehensive health care delivery services to its entire population
of 776 million through the Government machinery alone. The task has become all the
moredifficult in view of our commitment to reach HealthforAII by 2000 AD - atarget
which is being monitored by the entire nation if not the entire world. I am absolutely
clear that untit or unless wider and universal voluntary participation is forthcoming our
aim to achieve Health for All by 2000 AD will prove to be a mirage ever receding from
the aspirations of the people. The organisation of this workshop is a small but important
step in the gigantic task of providing our rural millions a package of comprehensive
health care delivery services.
'As you know health has been given high priority in our daily I ife and the concept
of health, including physical, mental, social and spiritual well being dates back to the
Vedic period. This cherished value regarding health is enshrined in the ancient Sanskrit
words ‘Sarve Santu Niramayaha’ which means ‘let all be free from disease and let all be
healthy'. Here I would like to quote our beloved late Prime Minister Smt Indira Gandhi's
words: ‘Life is not mere living but living in health. The health of the individual as of
nations is of primary concern to us all. Health is not the absence of illness but a glowing
vitality, a feeling of wholeness with a capacity for continuous intellectual and spiritual
growth .“Health for All by the Year 2000“ envisages strengthening of the public health
programmes of developing countries, where most diseases are concomitants of
economic backwardness.
“In this perspective, we have to understand that the health delivery system should
not mean treatment of diseases alone. The concept of positive health must percolate to
al I so that the people are no longer dependent on the present day curative health centres
and hospitals.
“The task before us is gigantic. The health movement has to be generated in order
to educate and involve people to create an environment free of disease. It is in this area
that voluntary agencies can play the most vital role. They have io educate and be the
watchdog of the people’s health problems. There are so many interventions which can
be carried out by the individuals and the community in the health field at a negligible
9
\ /
cost. Our people are intelligent and capable of following good advice as has been
shown in the agricultural sector where rural people have been very quick in adopting
new techniques in agriculture, leading to the green revolution. I am confident that if
proper attention and results are shown with dedication in health fields, a great
breakthrough will take place- in the health scenario.
The State Governments have already established a vast infrastructure for the health
care delivery system. However, the benefits have accrued only to a few people as the
health workers are lacking the motivation, the skills and the knowledge to function in the
communities where they are posted. This gap has to be bridged. Voluntary agencies
can play a vital role in this area. Training programmes suited to the local conditions can
be formulated and taken up for the improvement of the health delivery system.
~Another major thrust needed is change in the attitudes and beliefs of the
communities. This change can be brought about only by a band of dedicated voluntary
workers outside the rules and regulations of the Government system. It involves a total
involvement with the community, speaking their language, eating their food and living
with them which can be possible only if this challenging role is taken up by the voluntary
agencies.
We must not confine ourselves only to the health field but must broaden our vision
to the health related sectors which have a ditect bearing on the health of people, like
family welfare, immunisation programme, income generation, potable drinking water,
sewage disposal and literacy, specially amongst women. Voluntary agencies can take
up integrated projects for community upliftment with health as one of the components.
If the income level of the people improves, automatically there will be an impact on
the health status.
We should not neglect our own traditional methods of treatment of ailments and
indigenous systems of medicine should also be encouraged in areas where people have
faith in these systems. Yoga should also be encouraged, specially in schools, to keep
the young healthy. Health education should be taken up in a big way to provide
information on prevention of diseases as prevention is better than cure and with limited
resources, this would be the best approach. Voluntary organisations can play a crucial
role in spreading the messages of health, specially in the rural and remote areas.
I would urge voluntary agencies to take up integrated programmes of income
generation, creches, school health programmes, and formation of youth and mother
clubs. I would also urge voluntary agencies to sincerely draw up programmes to
supplement and compliment the efforts of the Government of India and State
Governments in the delivery of health care.
I have been told that there have been group deliberations on this important subject
and some important recommendations have been framed. I hope all these aspects have
been taken care of in the deliberations and group work. I would like to assure that these
10
4
\ /
30
recommendations will be given due consideration by the Government of India We now
need to evolve a machinery and methodology so that the energies and expertise of
voluntary organisations could be channelised through approved schemes of logistic,
financial and technical support so that Government machinery and voluntary organisations
can go hand in hand to ensure wider and universal voluntary participation in all areas of
health care and delivery."
At the plenary session of the valedictory function the consolidated report embodying
the recommendations of all the three working groups were presented by the
rapporteur-general Dr Almas All, and discussed.
(
The recommendations, as approved by the plenary session, are as follows.
RECOMMENDATIONS
1. Voluntary organisations (VOs) can assist in identifying needs and priorities of people
at the grassroots level and help communicate them to pol icy makers and planners in the
Government. Forums should be made available so that on the one hand, planners have
access to ideas about people's needs, and on the other hand, grassroots level workers
are able to influence and shape policies with regard to their own health. Voluntary
Organisations can thus play an advocacy role, presenting people’s needs and interests
to the Government.
2. Government should understand, collaborate and co-operate with and support
all V.os activities which reflect people’s aspirations and relate to the goal of health for
all. Under no circumstance should the Government try and impose its policies,
programmes and targets on V.os. A mutually acceptable and flexible approach should
always be worked out. Broader goal of health for all should be kept upper most in all
efforts of Government and V.os collaboration.
4
Target-oriented terms for the award and release of grants should not be made a
pre-condition. The voluntary organisations should be given freedom to operate in their
own style within theconfinesof the national objective of achieving health for all by 2000 A.D.
3. Selective core funding should be made available to V.os so that they can maintain
a minimum staff for long-term security and continuation of activities initiated. Maintaining
an up to-date register of all V.os could be one method of ensuring that all V.os including
small ones and those in remote areas, have equal access to this funding. Priority for this
core funding should be given to V.os working in remote, under-served areas, and with
the poorest and most backwardcommunities(e.g. tribals, hill people, women, Harijans).
11
314. Identification of Inputs
(i) Basic core funding support should be available to V.os from the Government,
as maintained earlier.
(n) Voluntary agencies (Volags) can assist in selection and training of health personnel at
the community level.
(iii) Volags can help to develop curricula and training programmes suited to
community needs. They can also assist in in-service training.
(iv) Government and Volags networks and inputs can be used to develop effective
referral systems at the grassroots level.
(v) Volags can work towards developing a base of health awareness in the
community through health education. This should be undertaken especially among the
most disadvantaged groups (e.g. women, tribals).
(vi) Volags can contribute their organising skills to spread health awareness about
specific local health problems (eg. guinea-worm, goitre, leprosy etc.). In this they can
involve educational institutions like schools.
(vii) Volags can help to disseminate information about existing government
programmes and facilities. For people at the grassroots level, this would include
information on people’s rights, specially with regard to their health.
(viii) Government can set up a mechanism to provide volags with up to-date
information on existing national and State programmes, policies and facilities. Information
generated at various levels by Health Services Research and Primary Health Care workers
and volags should be passed on to a national centre for health literature information,
namely the National Medical Library (NML) which in turn will repackage it for wider
dissemination.
(ix) Government can provide grants to volags to produce health education material
which are locally relevant and suited to people’s needs. Volags can help to develop
new locally relevant ideas on health education, communication and programmes.
5. Formulating a Plan of Action
The group felt that it was unable to develop detailed action plans, guidelines and systems
due to lack of time. It was felt that further representation from more volags working in
rural and tribal areas of States would be necessary. However, a few issues that were
raised are outlined below:
(a) A small group of representatives from a wide range of volags should be
considered to assist Government in developing a plan of action for further collaboration
and cooperation. This would also include examination of current policies, plans and
programmes. It will also serve a kind of "listening post".
A separate small group of a few voluntary organisations, Government agencies and
other institutions may be formed to work out the modalities of administrative relationship
between the Government and voluntary organisations in matters such as release of
grant-in-aid, accountability etc.. This may be completed within a period of six months.
12
4
3Z
(b) Funding should be decentralised and procedures simplified, so as to ensure
easier co-operation.
(c) Volag networks or nodal agencies at the State level, with contacts in remote
regions can assist the government in identifying volags who are also working in primary
health care and toward the goal of health for all. This identification would help both for
funding purposes and for collaboration in various primary health care programmes.
f
(d) In the light of the present problems in the matter of coordination and
collaboration, Government should encourage better State level coordination between
volags working for primary health care and the State Government.
(e) Volags should assist the Government in developing a more broadbased approach
through health care delivery as opposed to the current target-oriented care.
6. Health for All as a social goal has to be integrated with social and economic
goals and hence health strategies should be dovetailed with overall social development
strategies. It is thus important that there is effective coordination between health and its
closely related sectors like education, agriculture and food, safe drinking water supply,
environmental sanitation and other rural development activities. Government should
therefore encourage voluntary organisations to undertake integrated health and
development projects with multi-sectoral approach towards fuller and complete
socio-economic development. Mechanisms should therefore be evolved to have
standing interministerial committees within the overall responsibilities of Ministry of
Human Resources Development. This will ensure a ‘single window’approach as well as
ensure receiving support for the activities of the organisation by pooling the resources
of various ministries under the Human Resource Development Ministry.
This integrated approach should be made applicable at the State, District and also
Block levels.
7. A follow-up meeting to this workshop should be held after a period of about
six months to review the progress with regard to implementation of the above mentioned
recommendations.
u
8. It was brought out that in the Coordination Committee meetings on particular
project of collaborative nature, attendance is either very inadequate or nil. As a result
of this, decisions are kept pending and the programme objectives suffer. The
recommendations in this regard is that the attendance of Government members should
be made obi igatory. Coordination Committees at the district and State levels should be
attended by the Director of Health Services. If he is not available then a senior officer
should be deputed. Such Coordination Committees at the district level should be
represented by all voluntary organisations of that district.
9. Possibility of holding regional workshops should be explored.
10. Annual meetings of voluntary organisations may be held at the national level for
general review.
13
N (5)0 100
f
v ■-—
■
3^11. Possibilities to allocate definitely prescribed areas for voluntary organisations
could be considered as is done in Maharashtra and Gujarat in small scale, not with an
idea of privatisation of health services but with a view to commumtise the health
programmes and make them more participative in future.
12. There is a need to review the norms for giving grants-in-aid, keeping in view
the inflation and the norms being practised in a particular State. The budget fora block
period of three to five years should be approved at the stage when the project is cleared.
Seventy-five percent of annual grant should be released directly in advance to voluntary
organisations and the remaining twenty-five percent be released on fulfilling other
conditions. Wherever the funding has to be routed through the State, to eliminate delay,
the Centre and States should work out a streamlined process for quick release of the funds
13. A cell in the Directorate General of Health Services (DGHS) should be created
to coordinate with the voluntary organisations.
14. A Directory of Resource Profile of voluntary organisations indicating the area of
activities, manpower, expertise, source of funding etc. could be prepared at the cost
of the DGHS.
15. Training
(a) The following categories of personnel need to be trained:
Health Sector: Dais, village health guides, multipurpose workers, trainers of
multi-purpose workers.
Education Sector: Adult education teachers, non-formal education of teachers, early
childhood Care Centres and Creches.
Social Welfare Sector: CDPO supervisors, Anganwadi workers.
PanchayatsandZila Parishad:V\\\ase level workers and Members of Panchayats and
Zila Panshads.
Community Organisations: Members of Youth Clubs and Mahila Mandals, adolescent
girls, young women and opinion leaders.
Development Department: Functionaries at village and Tehsil level, Public Health
engineers and low cost sanitation workers, Officials of agricultural department and
extension workers.
(b) Topicswill vary with the types of department workers, nature of functionaries,
their job description and responsibilities. However, topics of health care elements,
concept of health and medicare elements of socio-economic development, National
Health Programme/Health Policy, community based rehabilitation should be covered. In
addition topics like managerial aspects viz. communications skills, leadership, motivation,
team building, materials management, personnel management and logistics should
receive special emphasis.
14
7
/
37.
(c) Voluntary organisations involved in field level training should have to their credit
service programmes, which are current and also have considerable past experience in
the field of primary health care. They should share experiences of their own as well as
make available the experiences of other service groups in the area. The training agencies
should be competent with considerable experience and should have requisite number
of qualified personnel for training. Such training institutions should have effective and
appropriate linkages with service and training organisations within the regions both
governmental and non-governmental in nature.
(d) The groups having realised that equal opportunities to voluntary organisations
are not available in the form of fellowships, and scholarships for training within the
country and abroad, it is strongly felt that adequate provisions be made, both monetary
and procedural, so that trainers from the voluntary organisations would have equal
opportunity to get exposed to the educational technology and experiences in primary
health care workers training programmes within the country, as well as abroad.
(e) Some voluntary organisations have developed the competence to organise
training programmes of a specific or general nature for various levels of functionaries
involved in primary health care in an innovative and anticipatory manner. Full utilisation
of such facilities should be made for training of government functionaries as well. This
would lead to appropriate change in the orientation of government functionaries and
expose them to various important elements of primary health care in the form of
community participation, leadership, team building and skills etc. They would indirectly
develop a positive attitude to the contributions made by the voluntary organisations so
as to provide them equal partnership in the health care delivery at the peripheral levels.
' I
(f) The group felt that adequate and effective support to voluntary organisations for
organising training programmes in which they have competence and capability has not
yet been sufficiently available from the State and Central Governments. Training being
an essential integral part of the health manpower development, needs provision of
increasing resources both at the Central and State levels to augment and strengthen the
voluntary organisations training capabilities. This will not only include financial allocation
from the Central and State Sectors but would also imply provision for availability of
material resources from the international agencies at par with the Government system
running similar programmes.
(g) A number of members observed that educational material and other publications
required for training programmes are available with different voluntary organisations.
However, proper mechanisms for sharing of this training material have not yet been
developed. Similarly though the voluntary organisations have the appropriate expertise
to prepare educational material required for training of primary health care workers, they
do not have enough support and opportunities to a very large extent forgetting involved
in preparation of such material. The group felt that the Central Government should make
specific provisions for promoting interaction between voluntary organisations and
Government training centres for sharing the education material already available and to
15
i
innovate, develop and prepare new education material fortraining purposes. This would
help in identifying voluntary organisations involved in preparation of education material
of a specific nature which could be useful at regional and sub-regional levels in a manner
that would avoid duplication of efforts and resources. In addition to these, a separate
provision for developing educational material and training of trainers in educational
technology so that voluntary organisations interested in getting involved in such activities
could be provided sufficient amount of funds. Training materials are indispensable for
the success of any training programme. Government should offer substantial financial
assistance both at the Central and State levels for facilitating the publication and training
requirements relevant to primary health care.
I
16
i
3G I
I
I
$
NATIONAL CONFERENCE
I
OF
VOLUNTARY ORGANISATIONS
ON
FAMILY WELFARE
(25th September, 1986)
AGENDA
♦
J.1
MINISTRY OF HEALTH AND FAMILY WELFARE
V
).
DEPARTMENT OF FAMILY WELFARE
NEW DELHI
MINISTRY OF HEALTH AND FAMILY WELFARE
WELFARE))
(department OF family welfare
agenda notes
FOR
national conference of
VOLUNTARY ORGANISATIONS
ON
25.9.1906
AT
9.30 A.M.
AT
VIGYAN BHAUAN NEW DELHI
37 I
AGENDA ITEMS FOR THE NATIONAL CONFERENCE CF VOLUNTARJ
ORGANIIONS” TCT BE~ HELD*AT VIEYAN' BHAUAN/ NEW’ DELHI’*' '
' ON* 2579“. 199'6 .......................................
~
1 •
Review of action taken on the decinns of the last
Conference held on 4.9.1995.
2.
Involvement of Voluntary Organisations for motivational,
educational Communication and service delivery aspects
for the promotion of Family Welfare Programme in rural
/lose-seoivod areas and urban slums.
3«, Need for grants to be given for flexible programming but
with defined goals.
4i. Integration of Family Welfare with Social
Welfare and
Developmental Programmes.
5. Provision of training facilities for Voluntary Workers.
6. Streamlining the procedure for grants-in-aid to Voluntary
0 rganisations .
7^ Revision of the prescribed rates of
grant—in—aid as per
the approved pattern.
8 • Evaluation and feed-back in respect of the work done by
Voluntary Organisations.
9 • Making the latest research findings reports available to
Voluntary Organisations for more effective implementation
of the Family Planning Programme.
)
ON AGENDA ITEPIS FOR THE CONFERENCE OF •/Ci
OV HELD^Ar VIGYAN 3HA
25.9.1 936
ITFM N0.1 :
1.1•
• ?W D?l hl •
—
Revieu of action taken or* the decisions of the
last Conference held on
At the last Conference held o
4th September, 1985
the participating Voluntary Organisations
were unanimous in
recommending;
(i) Expansion of activities at grass—root levels.
(ii)
Taking the Family Welfare Programme to the intcric
£
rural <areas and urban slums by the Voluntary
8 rganisations.
(iii) Participation of more and more Voluntary Orcj^nisatX
in the Programme.
(iv) Integration of Family r
'
Welfare
ulrh other Social,
Welfare and Developmental Programmes
The Voluntary Organisations hopefully uould have put
these suggestions into action.
1.2
Various other important suggestions mada at the last
Conference have also been given due consideration by the
Government, and, uhereever feasible, suitable action has bee
t a ke n:
.
.
(i) a Standing Committee for Suoporting Voluntary Acti
in Family Welfare, consisting mostly of voluntary
workers, has been constituted (vide Notification
at Annoxure-I). The Committee would provide
consultancy services, identify Voluntary Organi
sations which could promote F.U. activities in ru
areas and urban slums and recommend financial and
other support.
(ii) The State Governments would co advised to set up
similar Committees at the Stats level. This set
up will be institutionalised by constituting
similar Committees at the District level also.
>4 o ■
-2-
(iii) The Family Planning Association of India to whom
grants had been released to set up a small consulttancy and have a rolling Fund of f-.s, 5 lakhs For
inducting smaller Voluntary Organisations into the
Programme, have sanctioned two projects under
the Scheme, (This scheme can be considered For
extension to other National Level Organisations aFter
analysing the experience oF the outcome oF the grants
released to the FPAI).
o
(ivjVo~ontary Organisations are being encouraged to take
up the Maternal and Child Health (MCH) and Immuni
zation Programme as a part of the Family Uelfare
Counselling along with their Family UelFare activities.
(v) Series oF meetings with other Ministries/Departments
engaged in Social, UelFare and Developmental Programmer
have been taking place to identity the areas of useFul
activity in relation to Family UelFare. A Technical
Committee has been set up to draw appropriate models
For inclusion oF the F»U. Component in the training
programmes oF the Functional res of these Ministries/
Departments. They have also been requested to considor
the desirability oF issuing suitable Instructions to
the Voluntary Organisations engaged Ln their programmes
so that they may use a certain ameunt of money, say,
upto 5% oF the total expenditure towards Family UelFare’
Programme.
(vi) The Scheme of instituting National Auards to Outstanding
Voluntary Organisations (Rs. 1 lakh) on-'
-<<n rs
(Rs.53,000) dedicated to promote Family 'JSlfara is
under consideration.
\ )
7I
-J-
2.1
Involverr.Rr.t of Voluntary Orgjnisations for moti
vational, educational communicaticn ano service
delivery aspects for the promotion of Fami_y Lclfr.ro
Programme in rural and less served areas.
A point has been reached now uhere the Family Lelfere
Programme is progressing steadily and promises to gather further
^ooentum. This has boon due to educational and motivational
activities undertaken by the Governmental infrastructure and with
the collabcration of Voluntary Organisations.
In fact, it is
onvisagec to make Family Uelfare a Pfepple’s Programme duly
accepted by thn people in increasing numbers. Voluntary
Organisations have a vital role in achieving this objective.
They rave participQted in the past and demonstrated their
effectiveness in the areas in which they have been serving.
Problems emanating from infant mortality, ignorance and rrisconceptions about family planning methods, lack cf scientific
information about preventive and promotive measures to ensure
health to all m the family, inaccessibility of services to the
remote corners and concentration of the voluntary organisatioQjS
in urban areas need to be considered for designing future action
plans by the Voluntary Organisations.
2.2
The need for ‘amily Welfare work and motivating the people,
to accept family planning services is much-more in the village asd
in. slums than in the cities.
It is necessary that services to the
rural and lass-served areas are made available in the matter of
health and family welfare education, information and motivation,
prevision cf supplies, Pl.C.h. services and rudiments r. y mnd i r. in co
for common ailments; IUD insertions/sterilisations services/supply
of1 concraceptives and immunisation service should also be made
available in an acceptable and accessible manner.
Voluntary
Organisations should consider to extend their activities to the
rural ar.d loss-served areas and pluc.ge themselves into the
country—side to reach the unreached. The leaders of village
communities, despite their enthusiasm, are very ofser. unable to
take up programme and sustain their efforts for tho
uelfare of the cummunity due to paucity of resources, limitation
of mobility and ina Ju /iuny of access to services. Fary of them
-4-
V-^xuntary
are illiterate but with proper guidance f; c in
Organisations they can be made more useful to the community
and also helpful in furthering the message unde r tb.3 family
welfare programme.
2O3
The coverage of the rural and other less-served areas
is limited at present perhaps due to. orga.iisational and
financial constraints.
It is necessary that there is greater
interaction between the Government and tha Voluntary Organi
sations so that the valuable experience and the knowledge
gained by the Voluntary Organisations could benefit the entir*
Health and Frmily Welfare Programme undertaken by the
Government.
Where the Voluntary Organisations have resource
constraints, financial support can be extended by the
Government for expansion and consolidation of their
activities.
2.4
•
The participants may discuss .ways and means_.for expand
ing their activities to the rural .and urban slums areas. *
ft! ven
hereunder are some suggestions for con side ra.ticnj—
i)
Many of the bigger Voluntary Organisations are runnlrg
"-■Mobile Clinics. . They may be? encouraged and . persuaded to ado
certain rural/slum area and extend their activities.lnitiall
through Mobile Clinics and. subsequently through rural Famil
Welfare Outposts/Clinics ♦
The Voluntary £rganisations may be encouraged to adopi
ii)
some remote and difficult areas for an all-round developmen
and extension of Health eand*Family Welfare Programme, (The
areas to be covered may be earmarked for coverage according
to geographical jurisdiction «. by Voluntary Organisations, uh
may be willing to undertake and carry on this work. No pat
need be developed for such Voluntary^ 0rgamsations but a
lumpsum provision may bo made -by the-Government for activii
which rnay be specified.)
!
iii) N.S.S. Carols, which the people .now perceive as a joi
cooperative effort of the local community and the students
■
Association of India, Working Women’s Forum etc, who have
the potential to provide such services to the newer and smaller
Voluntary Organisations, can play a great role in this matter.
Much in this field is expected from the recently constituted
Standing Committee for Voluntary Action (S20VA) which shall
provide the requisite consultancy services to draw up project
proposals by the organisations working at grass-root level.
A rolling fund of Rs* 5 lakhs has also been placed at the disposa
of Family Planning Association of India to provide consultancy
services and also to fund smaller o rganisations.
/
-7-
A
Item No.3:- Need for grants to ba given for flexible r roar ■'.(•mine
but uith defined.jjoaJLs^
3.1
The Family Welfare Schemes for financial assi/t rica
Voluntary Organisations are mostly patterned sc'i
1 - a.
3 . sohomas
sS 1-
under uhich grants—in—aid are given for spncifjc
-
activities and in accordance with a pattern of os H
-V pir.’icing
?f’re
proscribed by the Government e.g. Stcrilxsation --'c ioiiomus, Post
Partum Centres, etc.
On the demand of the leluot. y Crganisations
engaged in the programme for giving some flcxibxli y eo them u.n
their approach -and implementation, aa new schcrrj called
Expuri
mental/Innovative Projects Scheme1 uas startoo Coxing rno year
1981-82.
Financial assistance is given under this scheme for
projects not conforming to any particular pattern bin uhich are
viable and aim to provide motivation, communication, ^ducai'in<^l
activities and services, or are otheruise of mnevotx.n^tur<^.
The keeness of the Government to popularise this schema can be
judged from the fact that the annual budget provision for this
scheme uhich uas Rs. 20 lakhs during 1983-84 and Rs. ^0 lakhs
during 1984-85, uas
uas raised to Rs. 90 lakhs during 1985-86- and
a still larger amount of Rs. 140 lakhs, has been provi-eo for
this scheme during the current financial year.
3.2
The participants may discuss as to hou bast they can make
use of this schema. Certain suggestions mentioned in item-2 for
exteriding the activities to rural areas and urban slums can also
be considered to got grants under thu scheme.
The newly
constituted SCOVA will also help the Voluntary Organisations in
drawing up project proposals (costing Rs. ono
one lakh and below).
3-3
Caro should, however, be taken to ensure that the Projects
are cost-effective.
The Committee set up by the Government to
I
draw up model schemes fcr the guidance of the Voluntary Organisatici
i
l.s already working upon a model for intensive NoH/Immunis
Programme in urban slums.
The objective of the Programme
^o extend the services under NCH/Immunisation Programme beyond
the outreach areas.
The Scheme when approved will be given wide
puulicity and tried on a pilot basis.
The participants may
tc discuss the areas in which they can successfully implement
the Family Welfare Programme.
-8-
I
I
\ /
- 8 Item No. 4
Integration of Family Welfare with Social Welfare
and Developmental Programmes.
The great s trength of the voluntary sector is their
voluntariness, commitment, dedication in the services they
provide and closeness to the people they serve, They are also
4.1.
more responsive to the new ideas because they enjoy more
flexibility in functioning as compared to the Government set-up.
They are more effective in the community because of their
relatively close contacts with the people an*4 working in
relatively informal setting while the programme ??«? • by the
Government machinery is likely to be taken as a more formal
programme and the corresponding acceptability mv accordingly
Furthermore, the Voluntary <?roanisations
enjoy greater confidence of the community beccuse o'* the help
they render in their socio-economic upliftment* this re8wits
be relatively poor.
in greater acceptability of the programmes by the community.
4.2.
The number of Voluntary Organisations working for
the welfare of the community is very large. Besides* Health
and Family Welfare they are working in the fields of education,
rural development, uplift of women, child care, etc. To quote
pome examples. Voluntary Organisations are actively associated
with
Adult/Non-formal/Early Childhood Education Programmes
Development of Women and Children in Rural Areas (3WCRA),
Training of Rural Youths for Self-Employment (TRYSEN), Integrated
Child Development Service (ICDS) and various Employment
Programmes etc.
4.3.
These schemes in the main aim at poverty alleviation of
people in the rural areas and improvement of habitat and phys.vcal
quality of life and majority of the beneficiaries of these
schemes are illiterate. The schemes require potential beneficia-ries to come to one place for either acquiring a skill or to
work. The opportunity of their com-.ing together could be
utilised to reach the message and facilities of the F.J.Programme
to these target groups. Various Voluntary Organisations of
..2
1
\ /
9 .•
different types, working for different purposes and providing
different typer of services, have one thing in common viz.,
their reach to the community is very large. Because of the
useful.services that they provide, their workers have earned
credibility and are in a position to spread th? message of
Family-Welfare and motivate and
and pursuade
pursuade the
the couples through
their organisations.
The Voluntary Organisations are in a bette- oosition
4.4.
to promote social acceptance of later age st msrrxage, child
spaeing among COuplBs uhere the
number of children to two, preferably to hs reached
before the wife is 30 and, immunisation of
mother and child/
children. Influencing social and cultural
ncrme and tradition
in order to prevent early marriages,
reform of marriage customs
including dowry and bride's price,
promotion of female education
and functional literacy, health
education i child cave (leading
to higher child survival) and
promotion of small family norm
would also be easily attempted
by the Voluntary Organisations.
''01Unt">' “^anls.tion, e„9aged ln dirf„Bnt ty(]es
163 may
"ay discuss
dlSCU” Uay’ •nd ”Bans f°r Intoprating the
c9t.„8 Ulth
th8ir
actiuity u.th
with their
F U Pro
F.U.
eHnle.lT83"’'
h "1C'3i
th«“
P-vlde
-tleittee Uh. W„L.ldn,
.eln intent
C””'JnlC»tlc’"- POPul.tin,, edudotlon ctc. The
n ion is to create awareness in the masses about the
the". iT
‘ "Sma11 Fa"i11'” norm ana 9uid0 tha"’ td a“»‘i °r
x sting infra-structuro of Health and remlle u8lrare
It
uou d be ldeal lf they coul(J
the
" •
eontraoentioos being s„ppll.d by tho Gou„nmenl.
reach “yv“°n
\
’ 7“
aUailiit,le “lthl" tha “idd"d‘y »"d
>™ng couples, they „ill be able to provide ad„lce
”h ”’“4“’ °nd intimetely Bnd 9uldB thB motivated coupies
to the Family Uelfare Service Centres.
' ..3
\ /
Ll?
- 10 Zufi.
Financial and/or technical support may he provided by
the Government to such Organisations
for integration of the F.U.
Frugramme with their regular activities at the grass-root level*
Help cf SCOVA may also be taken to draw the prefect proposalse
11
Item No. 5 :
Provision of Training facilities . or
Voluntary Workers.
n?
Training forms perhaps the m*
5.1.
of the Family Welfare Programme.
‘n ■
. in’--_:rf?-t rc /’c-'-'
Faml-; i-lcr.
touches the mrst ser^itivs areas of :f-Ll;i _ •?’ 'u p- r*. :•
It is, there fere, necessary to. orient' the . unci i .'nar 1. ? » a"; -11
love's to und^rs tard their ’'ole and to devrjr.r- noccssx'y skills
to be able co make the programme a success r
The probler. of extending the available training
5*2.
facilities has to b-? examined from tuc angles.
The Voluntary
Organisations at present engaged in Health and Family Welfare
activities, mainly In urban areas, have to extend their activi
ties to rural arid liss-served areas like urban slums and,
therefore, they will require more trained workers.
the Voluntary Organisations engaged in various
Secondly,
social, welfare,
developmental etc. activities have al.o to carry a message
on family welfare and, it would not e feasible to involve
them in Information, Extension, Communication (IFC) Programme
uithn’it proper orientation on objectives cf Family Welfare
Programme and
without curlirir.o their expected role in the
Pr ocram~ie<.
ror providing the training facilities for the workers
5.3o
of the Vc-lunta.’.y Organisations already enraged in Health and
Family Welfare Prograrrnrcs - the following suggestions may be
considered:
I).
Health aid Family Welfare Training Centres
(HFWTCs )
being run by the Union Ministry of Health and Family Welfare
and other similar Government Institutions may accept nominees
of such Voluntary Organisations in their training programmes»
They may organise short-term-peed based courses for the workers
of these Voluntary Organisations fcr which the curricuiam may
be standarciisedc
The areas' of training may be identified by
• .2
ro
th^Vo.L'jn tgrv lirganisatii ns .
Nocess cry .'inc::?ial * u
W..- prr.vidoa ,cr strengthening these institutions.
h ir:
At the uarn
t-icj rhe projects developed by the Voluntary Cruanisatiunu
may
include the training components so that requisite funds
eie
built in for this purpose in the project proposals.
II)
Leading/large Voluntary.Organisations, who arc
conducting training programmes for their own workers, may also
undertake training of workers of newer and smaller Voluntary
Organisations who do not possess such facilities. Necessary
financial assistance may be provided to those Voluntary Organi
sations for strengthening/enlarging their faculty and other
training facilities to undertake the training responsibility of
trainiTir other voluntary workers.
5*\\ .
For thB ^rkers of the Voluntary Organisations ■ engaged
in social uolfare* socio-eccnomir • etc. activities,.training teams
cou u bo formed which will be imparting training on family
welfare topics.
These teams would comprise trained menbere .
frohi amongst several other. Voluntary Organisations... Sudh
teams could go frOril p1.3Ce to place an(j crganigG shc_t
duration training workshops at the venue available in the- local
areas or the workshops could be held in State capitals or
District Headquarters which are easily accessible and can be-
--h.d by 0Vlj.-night journey.
'
Tn carry cut such training
workshops, these or g.anis at; or.s could be provided funds on the " "
basis of number of workers to be trained by them. 1 hue, for a ‘
batch of 40 workers’ training for one day, a sum of fc.400/may be provided. These workshops may be limited to one or two
days duration as facilities of stay and lodging may net be
available everywhere.
The participants may consider tho above
and
op a precise plan of action indicating
inter-alia their specific
comments on the following points s
suggest measures
VI Ous
to draw
..3
\ !
. e T5
5 >
1 denu ' f ir..: t i on cf th'
t'\
rs
e e
-Jiffcront c-iupits
v’ulurtcjy Or ranis at ions wh*.
-f the
rum iri-:
orientation training.
ii.
The contents
of
the syllabus and topics for oi v •
entation training.
iii. The duration of training/cr-ientation for different
categories of workers.
iVe
The necessity of refresher ci-ursj.s from time to time.
V.
Hou to expand the available facilities and the
plan for training at dif f e:>. ent levels
vie
Quantum of funds
or other types
of assistance
required for all the above activities.
5.6c
IL may be added that a series
of moetings ha-./o airaacy
taken place with the Winistrios/Departments
cf Rural Develop
ment, Ccopeiaticnf Education etc. tc examine whether the
component of family ijelfare could also be included xc the
training programmes cf the functionaries
cf these Departments.
N (So JOO
OZC '■fZ
COMMUNITY HEALTH CELL
321. V Main, I Block
Kortrnbogala
India
/
-,a.:
5 5
xi trcrmlinj.ng the rrucedorn ter r ?-nts -1;--■
to Voluntary Crganisati: na o
c • •
6’*1,
It has been the enderA/cur of the Government to ensure
that- the Voluntary Organisations engaged in^the Health a nd
•
;■
Family Welfare Programmes
do not face any unnecessary hurdles '
Houuvcrj
or bottlenecks in the implementation of the Programme.
difficulties do arise at times♦
Various remedial measures taken
by the Government on the suggestions made by the
Voluntary
Organisations are briefly narrated below:
I)
The major and recurrent complaint of the Voluntary
Organisations has been the delay in the release of grants to
them by the State Governments for the implementation of the
Government sponsored schemes. It has been impressed upon the
State Governments o,n mere than one occasion that bbs Voluntary
Organisations - especially the smaller ones - have limited
financial resources and are virtually dependent on grants-ir>^
aid for the implementation of these schemes and, that, they
;
•
should take immediate remedial action in the matter of re-leqa^.: • •
of grants. With a view to avoid delay in the release of grafts j ■
the powers of the State Governments to sanction Grants—irr-Aid1 ?
The State Govern-?;/’
for the pattern schemes have been enhanced.
ments can now release grants-in-aid upto a ceiling of Rs,05.ptir. l
lakhs per annum to each unit instead of the earlier ceiling
J ’
of Rs.2.50 lakhs.
Similarly, the State Family Welfare OfficQj*
\ has been empowered to release grants upto Rs.2.CO lakhs *
instead of Rs.50t000/— in urgent cases ♦
.
. ■
It is expeqted that- ’
f
With the issue of these orders 9 funds
1
for the Voluntary Orga'hi^
’
shtions can be released more
rs
'
expeditiously by the Statu
.f ’4
*•
.
1
■
:
•
.
* • I
‘ii
■■;
A ;
’*
.
■..
. «...
'•* ii.' • 1- *
Governments as the need for referenpes to the Cehtj’al GovergmtDt ••
for administrative approval would aimost be total'ly • e2simihat0di-.
' ’
■
>
'
■
v-
; ’
fl ’ t
f
:
‘
li) The State Governments have also been advised tO'fiakQ;
' ;
the fo^Llouing steps :
(a) Holding of meetings
of the State Grants Committee *
regularly and periodically.
w
.
' ;
s
: • •
y p: •_S u:' \ "
a-.L tT’-i 3 :
i'-'.’iai y f.)rgr/■ Is at if r‘3 a;.-j
of the f;
('amr.: it teas ;;c-nf v. itutC'-J at \'2r ?
.
~ia.-5 c;. □f' •
1 l-
or J -
in the Steve.
(cl Holding
of the meetings of the Voluntary Organisations
In the State frequently to identify other problems
feced and to find cut solutions to them.
training to the staff baling “ith rol""^
(d) Adequate
to ths Voluntary Oroanisotions in the
cf grants
procedureI thereof.
' > noted that the Government
It may alsof however, he
difficult to release the grants cn account
semetimes finds it <—-of the Voluntary Organrseticns
cf the short-comings on the part
of accounts
the
also, especially in the proper maintenance
Financial Rules are very strict
funds utilised. The Government’s
on the part of the Govarnmept
in this respect and, any lapse
It isj therefore, necessary
gives rise to audit objections,
also extend their cooperation
that the Voluntary Organisations
utilisation of funds and maintenance of
in the matter of proper
For thip purpose, the staff of the Voluntary
their accounts•
be properly trained in matters pertaining
Organisations need to
6.2.
to Accounts.
The participants may discuss as hou best seen
6.3.
k
be imparted to their workers, and what further
training may
^medial steps are necessary to remove the delays in
m the
release of grants.
x
'TY'
16
Revision of the prescribed rates of grantsin-aid as per the approved pattern.
I turn No.
7 :
7.1.
Representations are received from the Voluntary
Organisations
from time to time in regard to the inadequacy ,
and short comings cf the pattern of grants-in-aid released
to them as per the approved pattern of schemes.
points mentioned by them are as
Some of the
follows:
i) The salary and allowances allowed to be paid to the
staff are less than the corresponding pay allowed to the
Government staff, as a result of
recruit dedicated workers.
which it is difficult to
There are also no avenues
of
prometien to the staff recruited by the Voluntary Organisations
inasmuch as the patterns of grants-in-aid do not provide for
such contingencies.
No extra payment is made fcr the appoint
ment of a substitute whenever any voluntary worker proceeds
on leave.
There is also no provision of extra funds for the.
grant of Contributory Provident Fund by the Voluntary Organi
sations, which themselves depend on public donations and
have no extra sources of income and as a result, several
Voluntary ucckCM', who have dedicated their entire life to
social service, are forced to retire without any pension,
gratuity and sense of security in old age.
11) The rates of grants—in—aid prescribed for various
schemes viz.y Sterilization Beds SchemOj Post—partum Centres
etc. are very low on account of the increased cost of living
all round.
iii) The requirement of appointment of minimum staff
as per the approved pattern for some of the schemes like
Urban Family Welfare Centres needs to have a second look
inasmuch as qualified staff is not available within the
meagre grants
released for the purpose.
. .2
\ /
I
17
7.25
The difficulties experienc'd by the ‘
•.•.•nee j
Organisaticns in all these mettc.:- ’.ay be1 dlaejas-.d
d'.”ise
uays and n.eans as to hou they can be overcome so that fresh
guidelines for the release uf grants can be worked out.
But
it may also be noted thet Government funds are limited and
Voluntary Organisations should not depend entirely on grantsin-aid but supplement their efforts by their own services and
also a percentage of their own funds raised by Public donations.
It may be noted in this connection that on a suggestion made
by some Voluntary Organisations, the case for having more
liberalised income-tax exemptions on the donations made to
the Voluntary Organisations engaged in Family Welfare
activities is under the active consideration of the Government.
However, even under the existing exemptions, it
felt that
it should not be difficult for the Voluntary OrgaTnisations
to attract funds from philanthropic subscribers.
\ )
—j
vt -
- 'is -T
8.1.
X1
,
p
c-V'ilurt.-.un .if.--! f^-eJ bnr-< jn r-?r. dPcJ.
u'ur* r.one by Voluntary urjnriia
i< :•
'
Over the various plans, the Government have been
providing funds to Voluntary Organisations to secure their
involvement in accelerating the speed of performance under
the Family Welfare Programme to meet the national goals set
for achievement by the turn of the century.
There is, however,
no scientific feedback on the evaluation of their activities
and as a consequence, Cn the right utilisation of the funds
provided to them for such activities. In the absence of the
feedback, it is also not possible to consider hou an innovative
ami y Welfare Project being carried out by a Voluntary Organi
sation in a particular area can be suggested for trial in other
areas also. It is imperative that ue shall have an appropriate
sys em for monitoring the activities and getting regular feed
ack on these Voluntary Organisations some of which are getting
sizeable funds on
g
on aa rennin
regular basis, BBsideSf there
necessity for adequate
manpower both at the Central and State
levels to monitor the activities
of these agencies on a regular
basis. To supplement the monitoring,
it may also be desirable
to.have evaluation of their activities
to find out the weak
points as well as the Strong points in the implementation of the
programme by them s o
as to reorient further strategy. Such
evaluation could ideally be taken up by autonomous bodies like
the International Institute
for Population Sciences flomb-s^ jand
the .National Institute
of Health and. Family Welfare, or by
Population Research Centres etc.
3»2,
rhe immediate need is,
therefore, to systematise the
collection of data about the activities
of these Voluntary
Organisations at the national level
• and State levels and stanJardisation of records and returns
to be maintained'by thes e
agencies. Some key indicators for i
monitoring purposes to
assess their activities also need be
worked out. As a matter
of fact, a proper monitoring and evaluati
on machinery need be
provided for.
\ I
«• *i 9
Sr
••
0.3,
The participants may S Ik-j to
dp.ticna
in hh?s re jar J 5
Some
77
^u-
. I’S sp 3C ’-f
!' ,
s
could ho considered i;my b.<
•?•vJ .'Ouurn; to be
.It. r.dardisaU on cc :
nei-coined and f’-rrisnod by these agencies,
and
working out key indicators which could be
utilised for monitoring purposes.
ii)
The possibility of undertaking external evaluation
by independent organisations like I.I.P.S., Bombyys
NIHFUj Neu Delhi at an interval of 3 to 5 years.
iii)
Providing suitable staff centiunent both <-t
Central and State levels tc coordinate and monitor
the additional aspects
of evaluation in
Voluntary 3rganisationsP
20
Item No. 9 :
9.1.
Flaking the latest research findings report
available tc Voluntary Organisations fcr more
effective implementation of the Family Planning
Programme.
At present, 17 population Research Centres located
in different parts of the country besides State D&E Cells and
other research agencies, undertake Demographic Research and
Evaluation of Family Welfare Programme. The reports cf Research
Studies completed by these PRC’s are received in the Ministry
and summary findings which are considered important from the
programme point of view are prepared and circulated among the
Programme Officers for appropriate follow-up action and
reorientation of strategies. A Population Research Bulletin
containing the important findings from various research studies
with the Policy/Programme implications emerging cut of these
research findings is prepared on a regular basis.
This bulletin
can be circulated to the interested voluntary organisations
so that they also may derive benefits from such studies.
9,2.
Suggestions regarding the other ways through which
the services cf the PRC’s can be utilised by the voluntary
organisntionsf are£2 solicited.
\ /
{ Tg b_pu□ 1 ish *?d i n tJiGc
p India
•• ■ i
A;
No.R.170 !'!/^/'/!33-C4S
Gove mm.mt i;f India
Ministry of Health 4 Family delr
(Doptt. of Family 'Julfaro)
Neu Dolhi, dated 1 7/6/1 ^E’C o
RESOLUTION
The President has been pleased to uoci-ic t'l'i’ a
Standing Committee fur support tu Voluntary i'?g ’ : is t if ?s
should be constituted uith immediate effoct.
2.
The composition of this Committee! will bo
1.
Shrimati Sasmeeta Srivastava,
Chairman, Central Social Welfare Board,
Joevon Deep Building, Sansod Pla.rg,
Nou Delhi,
2,
Mrs.- Vidya Ben Shah,
Chairman, Indian Council of Child 'Welfare,
4-Deen Dayal Upauhyn Marg, Neu Delhi.
3.
Dr. (Mrs.) Lolita Rao,
Ex-President, Indian Medical Association,
141, Kailaeh Sion (West), Bombay.
bomber
4.
Mrs. Jaya Arunachalam
President, Working Women’s Forum (India),
55-Bhimascna Garden Road, Ply lap ore,
Ma dras.
Mambor
5.
Shrimati Verna W. Ingty,
flombar
Chairman,
Meghalaya State Social Welfare Advisory Board,
’’Thule Cottage*1, Llmmaurio,
Laitumkharah, Shillong (Meghalaya)
6.
Or. (Mrs) Ragini Bohn,
Banu-osi Seva Ashram, Mirzapur (UP)
Plan bar
7.
Hrs. Nalini Nayak,
P.U.O. Centre,
Sponcer Junction, Trivandrum (Kerala)
Homber
D
Smt. Rami Chabra,
Adviser (Mass Heeia & Communication),
Ministry of Health & Family Welfare,
lieu Delhi.
Ex-cf fic io
Plumber
Miss Mira Seth,
Aobit tonal Secretary \ Commissioner (FW)f
Mir. is tv/ cp Health & Family Welfare,
Nou bo.lhi..
Ex-officio
9.
Ch zircon
-
.■|cmb:JT
phm bc'. r
\
-2-
()0-
w.
Shri R.M. Bhargava,
Joint Secretary (FA'
Ministry of Health & F.W., Neu Delhi.
ox-off icio
Member
11.
Shri Palat Mohandas,
Joint Secretary (fID),
Ministry of Health d F.W., Nau Delhi.
- Convener &
Member Secy.
3.
The terms of reference of the Committee util be
as under.ji) To consider applications received from voluntary
organisations (agencies) working at tea r-.’nss-rcot
level in the rural and urban slums for soriinn
it?n uo
Family Welfare Projects relating bo MCh,
•1 v
Planning, Improvement in Health stair-_•
"o Tiqso
uhich integrate the present activitJ_s
vuluntaiy
organisations with Family Welfare
Welfare and r'i. .•rv.nd
those found feasible to Government for rciease
of grant-in-aid.
11) To encourage community action to generate new
ideas and approached that will ultimately lead
to the improvement of health standards cf the
people at reduced costs and create greater selfreliance in the rural and unserved areas.
iii) To entertain <and consider projects adopting the
traditional systems cf medicine for achieving
the desired purpose.
iv) To document and list all voluntary organisations
^agencies) working in specific areas concerned
with
the Ministry of Health and Family Welfare.
- _..j
v) To prepare case studies/Profilas of voluntary
agencies tet draw lessions from such grass-root
experiences uhich could be used to influence
policy and draw up now schemes more suitable for
target groups living below the poverty lino.
/
The grant-in-aid recommended for a project shall not
exceeo Rs. 1 lakh
'
for the project period uhich may vary
from one to threo
-- * years.
5.
The term of office of non-official members will be for
3 pericc cf 3 years with l/3rd of the members
------ j relinquishing
office every year.
6.
The Committee will held its meetings as often as necessary.
T.A. and O.A. to non-tofficial
' 2 members for attending
the meetings (of the
‘ ‘
Committee shall be regulated in
accordance with the pravitions of S.R.
150 and orders of the
Cover nmunt
----- - of India thereur.dur as issued from time to time.
*>
I
-3The expenditure involved will be met from within
■
8.
sanctioned budget grant under the Major Head of Account
the
.T-GL'i.-r Services and Supplies, h. i
281-Family Welfare, A.7-0ther
us
A«7(l0)(6)-lnvolvement of Voluntary
(1Q)-Other Schemes. A7?10)(6)(1)-Grant-in-aid under Demand
Organisations, A.• 7\
v z
M \•/ --- - 1986-87. The expenditure
No. 46 Familv Welfare for the year
is to be booked as ’Plan Expenditure .
Sd/-
( Lata Singh )
□f India
Joint Secretary to the Govt.
No, R .1701 1/34/65-c&G_
Ordered that a copy of
of the
the notification be communicated
to all State Governments/U.Ts. and that the Ncti
c.n.
be published in the Gazetee of India for general in
Sd/“
( Lata Singh )
Joint Secretary to the 'ovt. of India
To
The Manager,
Govt, of India Press,
Mayapuri, Delhi
Copy to:
i) All Members.
ii) All Ministries/Departments of Govt, of India
iii) All Health Secretaries of Stato Govts./U.Ts.
of Ministry of Health
iv) All Officers/Sections
L
.
and Family
Welfare, New Delhi.
v) D.P.I.G./P.I.B.N.D. for wide publication
vi)
P.S. to HFH/n.S./O.n.(FW)/Secretary/
A.S.iC.(FW)/A.S. (FU)/A.S. (H).
Sd/( K.K. Saxena )
Under Secretary to the Govt. of India
\ /
K-Guidelines for Financial
under Aeljino.
’ ...
1. The nodal organisation 3pProvod^r.d.r
will identify the NuC. f ^1]Qr orQ^nis^i ons,
Scheme and will °ls0
. DrOnSCts. ...erore
if need be, to formul. t ■ _
n...niscions, apprnv; 1
sanctioning grants to sue
-obtained by the
of the Government of mdi. ui;i
Nodal Organisation in each c-e.
2- ?oe.’7nNG0 Shd.: ?hnns=hejee.nheu|d
Rs. 1 lakhs during a financial ye
statement of Xm^u'X'mnlstry
3. A Quarterly under the Scheme
vill following
oe
month
sachF^rt|o that
by 30th of the
recoupment offsK-^t ^T.e:dt’an°y ste9e.
it does not f4. Quarterly progress ^P^s^^a^onsolidate^
^?m for'^ormation/revieu.^These^ill^Iso be
guidelines'to^NGOe m Improvement of performance,
wherever considered necessary.
■ i the
s. The nodal organisation ulll monitor/ovaluote
Technical assistance
project periodically, Pr°vJ-?® .
p;nd%i
J So' collect
\ Annual Audited
of
from NGOs
NGOs and
end furnish
^^.d
thefo?m
sameduly edited to this
India in a consolidated form huy
f the
Ministry within six months of the close
Financial Year.
6. A separate Sank
Bank Account will
“i^^^/Jpe^t^inspection
be
<--- — s
purpose.^ These accoun
reserVeS the right to
and the Government of In
nraanisation audited
heve the accounts of the Nodal Organis
.f
by the Comptrolierand Audit
G
satisfy
and when occasion demanos, in or
affairs
themselves regarding the manner
*a.
of the Nodal Organisation are being
9
7, The above Rolling Fund shall not fall short
Rs, 5 lakhs at any time.
-2-
\
B-
•2<
•
8.
The nodal org^ni'Ration will toe responsible for
the proper utilisation’^f-the\ahovnt odv^nced
to it for. disbursement to NGOs and due safegu-rr-s
will be .observed: while releasinn .the .amount to
NCOS. ••• ''
‘ '' ''
-
9; •
The•’a-nouh.fuiU be • utilised, for. furtherence of
:thc.Family Welfare Programme only ingludimo
PICH a,■ Primary Health Care. '
Thefnodel Organisation will -he orovided assistance
•for maintenance of a small NGG Cell for imglementstionr-df the Rolling fund -Scheme
• -
i
I
\ /
1//I
PERSPECTIVES
India became a signatory to the Alma-Ata declaration in 1978 committing itself to
achieving Health for All by the Year 2000. In 1982, the revised National Health Policy
was adopted in the Parliament. The National Health Policy (NHP) lays considerable
emphasis on preventive and promotive aspects of health care, greater decentralization of
services, self reliance through greater transfer of skills to and participation by the
community and development of an effective health care system. Therefore, programmes
involving the active participation of Voluntary Organisations and mounting of a massive
Health Education movement should be accorded priority.
Keeping the above goal in view tlie Government of India has evolved various schemes,
under whic.i financial assistance is being given to projects undertaken by Voluntary
Organisations for expansion of Health, Family Welfare and Nutrition services in various
parts of the country. To ensure effective implementation of the project at state level a
nodal officer for NGOs is identified. The present workshop broadly aims at sensitising
and orienting the nodal officers on the need for involving NGOs in health care projects,
providing the participants with insights into tlie concept, approach, scheme description,
scope of activities eligible for grant, processing proposals, disbursing grant and follow
up etc.
OBJECTIVES
The specific objectives of the workshop are:
1.
To sensitise the state level nodal officers on the need for involving Voluntary
Organisations in health care projects.
2.
To appraise them with the concept, approach, scheme description and scope of
activities eligible for grant under various health schemes for Voluntary
Organisations.
3.
To analyse and understand the areas where Voluntary Organisations could be
involved and where they need support etc.
4.
To provide orientation to the participants on scrutiny of project proposals,
disbursing of grant and follow-up etc.
5.
To identify the “training needs” of nodal officers for effective implementation
of various schemes for Voluntary Organisations.
6.
To determine the support structure required by the nodal officers foreffcctive Co
ordination between voluntary organisation and government.
7.
To develop appropriate monitoring and evaluation mechanisms to ensure proper
implementation of such projects and
8.
To imiate Voluntary Organisations into sustainability Planning.
zi
A
I3,
Az
^r-
Background
The National Family Welfare Programme seeks to promote family planning as a peoples’
movement. The vital role of voluntary organisations in promoting the family welfare
programme has been recognised and given importance from tire very beginning. They
have been participating in many schemes and bridging the gap between the community
and the Government Services. These organisations having their root in the community
and due to the fact that they encounter less of cultural and geographical barriers, have far
greater acceptance than the Government functionaries. However, inspite of various
initiatives taken in this direction, participation of voluntary organisations has not been
to the extent desired. Reasons are many. Some are enumerated as under:
7.
Lack of knowledge of Government schemes.
2.
Lack of knowledge of Government procedures.
3.
Lack of resource mobilisation and sustainability.
4.
Lack of ability to do financial management and monitoring.
5.
Inadequate inter-mingling with Government personnel.
It often happens that even Government personnel in Health and Family Welfare arc
involved in day to day crisis and epidemics and do not get an opportunity to look into the
problems of voluntary sector.
With a view to boosting the activities of the voluntary organisations for meaningful
participation in the national programmes, a number of initiatives have been taken by the
Government in the recent past. A few are indicated below:
i.
Publicity is being done through TV/Press about schemes existing at present.
a.
State level committees comprising of the representatives of State Governments,
Voluntary Organisations and Ministry are being constituted. These committees
will recommend projects in family welfare for funding and also arrange necessary
training to voluntary organisations in project formulation and management.
Hi.
Adequate training facility for voluntary sector will be developed in each State at
least in two places - one within the Governmental Sector and the other in NonGovernmental sector. Various aspects of family welfare including services/
education, etc. are to be covered. In addition, training will also be imparted in
projectformulation, financial management/monitoring/evaluation/sustainability.
iv.
It has also been proposed to hold periodical training/ meetings/ seminars/ study
tours of the volunta y sector for sharing experience and ensuring interaction
between various organisations.
XoGH rx?.
'Z
cr
£6’
V.
Action is being taken to set up an apex body viz. VAFAH to administer all grants
to voluntary sector. This body at the centre will also have regional bodies and will
enjoy sufficient flexibility and autonomy. Through these bodies the goal of
making family welfare a people’s movement may be greately achieved.
vi.
Grant-in-aid procedures have been sufficiently de-centraliscd through setting up
of rolling funds for involvement of small voluntary organisations.
vii.
To involve more and more organisations in tire family welfare programme, to
acquaint them with Government schemes for financial assistance and for
meaningful exchange of views, five regional conferences of voluntary organisations
were held last year in Patna, Calcutta, Madras, Shimla and Goa. A large number
of Voluntary Organisations participated and there were useful interaction.
Through various new initiatives, there has been sufficient awareness among the voluntary
organisations about the various schemes running at present. However, there is still
hesitation among many of them. One of the reasons may be the strict procedures/
limitations within which the Government functionaries are to work. Also in the absence
of specific levels in the State Government which arc responsible for dealing with and
providing guidance to voluntary sector, response from the voluntary sectors has not been
adequate. With a view to removing this impediment, all States/Union Territories have
nominated Nodal Officers (Government officials) who will be primarily responsible to
receive proposals from voluntary organisations and for rendering necessary guidance to
them. However, because of the situation under which those officials work, often there is
lack of understanding towards the voluntary organisation sector. It has been considered
that the Nodal Officers themselves may need some orientation about the schemes which
are running for voluntary sector and the difficult condition under which they are working.
Only when these are realised properly, our attitude towards the voluntary organised sector
will undergo the desired changes. This will greatly help in effective implementation of
national Health and Family Welfare Programmes. Following are the main schemes for
financial assistance under the Central Sector:
I.
Innovative and Experimental Scheme
2.
Mini Family Welfare Scheme.
3.
Performance Linked Model Scheme.
4.
Private Voluntary Organisations for Health (PVOH Schemes).
1 u ,)
■ /~
-'S
f ■ ■ • -- - ;
J,
r
I ' 'I ' '
!
f
SA
\ )
bl
Specific Areas Needing Attention of Nodal Officers
Project Formulation
A number of Voluntary Organisations are working in various parts of the country. Most
of them arc working on their own. A numbr of these organisations are desirous of availing
assistance available under various schemes in the field of Family Welfare and Health. The
Nodal Officers have special role in guiding the organisations in proper formulation of
project proposals. The guiding factors may be (i) selection of proper area with a view to
avoid duplication; (ii) adequate survey of the area to assess the actual need; (Hi)
mobilisation of existing resources, manpower, etc.
Financial Management
Adequate care is to be taken to make the projects cost-effective, as far as possible. The
voluntary organisations have to be told clearly that they should not compare themselves
with Government organisations in the matter of pay-scales of their employees, creation
of infrastructure, etc.
Monitoring and Evaluation
These components are necessarily to be built in the project, periodical monitoring, both
physical and financial, at different stages of running of a project are as important as any
other component. Based on developments, it may be necessary many a time, to modify
a project design to suit to any shift in policy or otherwise. Although the organisations are
to run projects within certain defined parameters, they should not be subjected to rigid
rules. The experience gained in a particular project may also be suitably utilised for
similar other projects. The Nodal officers neeed to develop flexible attitudes.
Sustainability
This is a very important aspect which needs to be given special attention. The
sustainability element needs to be properly nurtured from the very beginning of the
project as also at different stages of running of the same. The ultimate aim is benefit of
the community. Different aspects, such as income generation activities, exchange of
experiences, changing project design with changes in policy, etc. have to be constantly
kept in view. Another important aspect is cost benefit analysis. This exercise has to be
undertaken regularly and necessary changes made to make the project really sustainable.
Recommendations of State/Union Territories
Voluntary organisations arc required to work in close co-operation with respective Stale
Governments/Unior Territories. As such, specific recommendations of Statcs/Union
Territories arc very essential. The nodal officers being Govt, officials themselves, it is
expected tliat necessary clearance from Statcs/Union Territories will be expedited.
PRIVATE VOLUNTARY ORGANISATIONS
FOR HEALTH (PVOH-II) SCHEME
7.
The PVOH-II Scheme which is a sequel to PVOH-I Scheme was formulated on
31.8.1987 by virtue of an Agreement signed with the USAID who agreed to fund this
Project with 10 million. The Project Assistance Completion Date which was earlier
30.9.95 has now been extended to 30.6.1997. The unique feature of the Scheme is the 25%
contribution of the Voluntary Organiation towards the total cost of the Project.
2.
The Project seeks to reduce morbidity, mortality and fertility among the rural and
urban poor in the country. The pupose of the Project is to expand and improve basic and
special preventive health, family planning and nutrition services for the poor by
strengthening the private and voluntary sector with special attention to less well served
areas and deprived population.
3.
About 40 sub-projects are to be accomodated under this Scheme and so far 18
Projects have been sanctioned. The life of the sub-projects is approximately 5 years.
4.
The National Institute of Health and Family Welfare has been entrusted with the
task of regular monitoring/mid-term and final evaluation. The Instiute also provides
necessary guidance in Project formulation/revision, baseline survey, preparation of
action plan, setting up of operational targets, recording, reporting and supervision.
☆☆☆☆☆☆☆
SCHEME OF
MINI FAMILY WELFARE CENTRES' AS A MODEL UNDER
INNOVATIVE SCHEME OF GRANT-IN-AID ASSISTANCE TO VOLUNTARY
ORGANISATIONS FOR PROMOTION OF MCH, IMMUNISATION AND SMALL
FAMILY NORM
OBJECTIVE
1 .
Fami1y
The d a sic approacn of tne model is to establish Mini
Wei rare
to
Immunisation
of
Fami1y
Cent res
promote MCH,
We 1 fare
p rogramme
section
of
population
amongst
the
resis t an t to Family Welfare Programme and having high
Ibirth
town
r a t e s.
This
wi 1 1
be app1icab 1e to
and
city
up to
population
of 1,00,000 and rural areas.
Preference under
>
tne
Scheme
will
be given to such districts
not
as
have
achieved
Couple
on
Protection
IRate
<CFR)
of
40% as
31.03.1989.
A
list
of these1
districts
attached
at
Anne '<u re - 1.
The od iec11ve of the Scheme will be entirely motivational to
ereat e
a
1ink
between the infrastrueture
Hea1th
and
of
Fami1y
we 1f are
facilities
and the community
to
promote
responsible and healthy motherhood and sma 1 1
fami1y norm.
As one of the major problems confronting the
imp 1 ementat ion
of
the
Family
Welfare Programme is that
inspite
of
the
existence
of a network of facilities, the
commonities
are
not fully aware of the need for services and i n this
regard
the
w o r *r: e r s under the Scheme can be utilised
as
ef fee t i ve
link
workers
to
,
create
awareness,
generate
demand
far
services and ensure1 utilisation thereof.
3.
The salient features of the Scheme ares
3.1.
The Scheme of Mini Family Welfare Centres will be «operative
amongst
the
population group resistant to
Family
Welfare
Programme.
For urban areas, it will be limited to slum
and
areas, in towns with population
unauthorised
ranging
upto
one lakh.
In the rural areas the thrust of the Scheme
wi I 1
be
in areas having very low CFR.(i.e.in districts with
CFR
upto 40%).
3.2.
The object ive of the Scheme will be entirely motivational to
serve as a link between the infrastrueture of Primary Health
Cen tres,
Sub-Divisional
Hospitals
and
Family
Welfare
Cen t res,
Voluntary Organisations HospitaIs/C 1 inics and
the
Communi tv.
T
-> . T
The population to oe covered in urban areas will be
diviaed into five field units of 5000 each. In rural
the
population
to be served by each unit will
be
consisting of five field units of 3000 each.
1
25,000
areas
15,000
< /
3. 4
Structure:
"1 0
Each
project will consist of ai Mini Family
Welfare
Centre
(MEMO with a Unit Coordinator' -as Incharge. Each Mini Fam i1y
We 1 fare
Centre wi11 have five field units.
In
each
field
un i t
there
wi]1
be
five sahelies
to
be
selected
f rom
Anganwadi worKers, Ba 1 wad i Teachers or'
or any i nst ruc tor'
under
these
Schemes
n the area of
located iin
operation
of
op era 11 on
these
pro jec ts.
The!■
wor l:ers from community
lady
workers
commonity
can
also
be
appointed
as
sahe1i
< i) if above named
worker's
are
not
w11 ling,
( i i) due to specia 1 requirement of the
segment
of
population to be covered, One of the sahel i worker's will
be
selected
as Group Leader after ascertaining the
leadership
quality and watching their work f or ahout th ree mon ths.
-7-
—' • cr1
The
Mini Family Welfare Centre and tne field units will
be
forma11y
attached to the nearest primary Health
Centre
in
the rural areas. and to the local
1 oca 1 hospita1/dispensary run by
the
Government
or' a Voluntary Organisation
in
the
urban
areas.
4.
This Scheme is both for' urban and rural areas. Throughi
this
mod el, a 11 emp t
to reach the grass—root levels and
icreate
awareness in t h e community served in a phased manner step by
step
from
the
very
beg inning
of
family
formation
i . e. mar r- iage .
In a gradual and step by step method the need
for
MCH
and
family planning is generated
as
the
fami1y
develops
keeping
touchi
a
continuous
with
the
bride
developing into a young mother.
mother'.
She
!
is also trained in
the
art
of motherhood
motherhood by the grass-root
grass—root level Voluntary
worker
known as 'saheli
in this model.
sahel i
model, This trained mother' becomes
an agency herself for passing these traits to the new brides
in her family and those in close proximity,
Thus,g radua11y
the MCH, Family Welfare motivation would progress in a chain
like
manner
and
in due course the
worker
will
have
to
concentrate
on lesser number of families and
contact
with
trained mother would be of maintenance character.
Mini Family Welfare Centre
:
The
Mini Family Welfare Centres will have five field
un i vs
and each unit will serve a popular ior, C" 3C«' i n rura. I areas
and
a
population of SuOo in urban
ar'eas.
: he
fol '• owing
cond itions nave to be fulfilled;
( i )
The Mini Family Welfare Centre will be
be situated in the
at'ea
of
population served by it.
Its five field units
will
be
disbursed around in the area of operation.
( i 1 )
The Mini Family Welfare Centre will be attached for clinical
and referral services to the nearest k’HC or Community Health
Centre
or
Urban
Lentre
in
city
area
or
Voluntary
organisat ion Hospsta1 C1 in ic to be speciiica1]y earmarked in
this project.
n i
supp i
J i i -i?
Fam 1 iy Wc i f ar-:- Centre wi. 1 serve as a
Depot
o n t r' a c e p 11 v e a r» d o m s a. n d o r a 1 p1iIs.
/
7) ,
( i v)
The
Mini
Family Welfare Centre will serve as
a Un 11
for
Community
uplift
by (i) Imparting Health
Education,
(ii)
training married young women in the art of motherhood,
.
(ill)
immunisat ion
in children and mother's;
mothers; (iv)
motivating
the
not'm
specially the target couples the
community
community
and (v) ensuring proper sanitation and hygienic conditions.
( V)
The staff should be employed from the community to □e served
spec ].a 1 1 y
the grass-root level worker the Female
Vo 1untary
Worker 'Sahe1i ' .
hj.
The
□asic princiole involved i n t h e success of model is
to
c rea t e
r ap p o r t
with
the new1y wed b ride
the
and
follow
co lid 1 e
•uh rough
t he i r r ep r oduc t i ve
phase
including
f i rst
pregnancy, delivery, post-natal care, spacing of
pregnancy,
second
pregnancy
and finally
ster
s
ter 1i
isat
sat ion.
During
Du ring this
follow-up she will be educated and helped as the need arises
in
various phases step by step, ensuring a healthy
marital
life,
healthy pregnancy period, s ■ fe delivery, healthy
and
trained motherhood and finally ensuring spaced small family.
This
step by step approach will provide complete MCH cover
and Family Planning. This approach will produce well trained
mother'
who can
help other' newly weds in
her'
family
ana
n e i g h b ou r nood .
(a. •
Methodology:
In
average there are three to four marriages
performed
in
each
marriage season in a vi11 age/cover area of an
average
■5OO to 10O0 population.
<b)
First Step:
To
establish rapport with the Newly Weds and
their
fami1y
and this is done by Sahel i. (Family Female Voluntary Worker)
by
ensuring
her'
presence in
the
marriage
and
creating
c1oseness
to the family. This primary
rapport
with
family of newly wed and the bride herself will open the path
for' consequent visits.
<c>
Second Step:
The
worker pays a casual visit to know the welfare
the
of
newly wed and creating personal friendship with her.
This
may be done at a convenient and congenial time.
(d)
Third Step:
During
the casual visits 'Sah e1i ' (F ami1y
Welfare
Female
Voluntary
Worker)
may come to know about
the conception
accru ing
in
the newly wed. From this, the visits
of
the
worker' is goal oriented and purposeful,
The Worker
shou. 1 d
s tar t
the
educating
the would
oe
mother
regarding
and
concep 11on, pregnancy, nutrition, for mother and child
few
do'S and donts in sanitation. During this
visit
the
Worker
mother
should congratulate and encourage the would
and take her into confidence.
This is the best period when
the young mother is most receptive ard
and inquisitive to learn
about motherhood in confidence through a friend.
T
< e)
Fourth Step;
The
would-be mother is gradually prepared to come
to
the
primary Health Centre/Hosp11a 1 with the help of e 1 der fami1y
members specially the mother-in-law.
T h u s t o rou t me
an tenatal
I
help
is provided and would be mother i s
to i d
abou t
hea 1 thy
mo the rhcod,
pro tec 11on
of
self
f rom
tetanus,
nu t ritive
value of specific feeds to be taken and
ro1e
or
san11a 11on
in pregnancy and delivery. She
educatedl
tor
prepar i ng
for”
cloths
for
de li ver” y and
the
child
to
come.
Complete checking is done at the nearest
Centre and if
she
is
a risk case, she should
be referred to Community
I
Hea
1 th
Centre.
Thus at one side the would-be mother
is
educated
for motherhood and a t the other” side she
g i ven ful 1 an tenatal services and c a r e .
(f )
Fifth Step;
Sahe1i
(Fema 1e
Fami1y
voluntary Worker)
thus
fu 1 1 y
prepares the would-be mother to have safe healthy
deli very,
physically and
mentally.
bhe
should
oe
She
motivated
for
delivery at home or Community Health Centre or' a Hosp 11 a 1 as
toe
case may be. The Voluntary worker should,
as
far”
as
possible,
at tend the delivery for'
attend
providing
psychologic a 1
i n the mother-to—be.
confidence in
<q)
Sixth Step:
The
new
mother
now prepared to
1isten
about
spacing
Copper
methods and be made interested in the use of Nirodh,
'T',
oral pills.
The need of spacing be generated
th rough
about t the healthy development of baby if
spacing
know1edge
is adopted,
Also Family planning is talked casually and
if
the meed is generated services are provided.
(h )
Seventh Step;
If the need for second childI is shown in a strong manner the
the
second
help
her
through
Worker
shou1d
wait
and
I
pregnancy.
mother
But usually for the second pregnancy the
second
be repeated for
the
is
fully prepared.
Gifts may
i
deli very
a f ter
to create a f i na 1 approach to
s t ar 1isat i on
second delivery.
Thus,
it
seen that step
is
by step
the
young
lady
is
approached
as
educated
per need creation and
heIped
and
she
g radua1 1 y
when
is fully receptive, A person
not
i=
receptive
for everything, every time but she becomes
very
receptive at the time of need and this 1 s the key of success
i n above methodology.
Second 1y,
this> Scheme ensures a creation of
who can become a natural t rainer i n future.
tra ined
mother
Third
advantage is that the image of the
(Ferna 1e
Saheli
Family Voluntary Worker) gradually grows and in this way she
is
herself sought for reducing her work gradually and
a 1 so
the number' of visits in the later period.
4
/
-73.
Four t h 1 y ,
it may be seen that in operation-wise the scheme
may look as slow a nd c u m b e r s o m e b u t p r a c t i c a J 1 y a f t e r p roper
schedu1 i ng
the
isits it is not difficult to follow
in
a
sma 1 1 popu1 at i on of 1 C'C’O peop 1 e in
i n urban areas/60<> i n
rura. 1
areas.
( 1 )
Besides
this,
step-by- s tep approach i n respect
new 1 y
of
weds, the 'Sehali
shouId inc1uoe a 11 t h e eligible couples,
in
p ar 11c u1 a r, of the younger group, in her target
group.
Her”
services
may
be u 111ised
a.s
Depo t
Ho Ider
for
d istribut ion
of
con t racep11ves
so
th a t
these
become
avai1ab1e
to
the
el ig ib1e
coup les at
the i r
door-step.
The
Sahe1i
shouId
also
ensure
that
a. 1 1
the
chi1dren
including
the new-born babies and pregnant 1 adies
in her
area
a re provided proper immunisation
services.
Another
area.
in
which the Saheli can play an
importan t
role
is
main tenance
of proper'
san itation and hygienic
conditions
in her a.r’-ea..
The
are:
mo s t
i /
F' r ooer
seiection of
Saheli' (Family
Female
Worker)
which may
i
be easier for a Voluntary Organisation to
do
due toi their
close proximity with the
community,
The
Sahe1i shou1d be necessarily selected
from the project
area
11se 1 f
and
from
the
target
commun11 y.
This
requires
to be ensured pat't icul ar'1 y in respect of
the
communities which are traditionally resistant to family
p 1 a.nn i ng .
i i )
Continued
and proper education of
Saheli' who i s
key person of the scheme is very important^
iii/
Besides
the remuneration admissible, the
motivationa 1
and other benefits for ster 1isa11on, IUD and Copper
insertion will be according to the rates prescribed
by
the state government in addition. She will also have to
promote
sale of commercial variety of condoms
as
per
rates specified.
important points for the success of
the
senerne
the
Arrangement for training of sahelies, unit coordination
will
be
made at nearest F*HC or Postpartum Centre
or
Urban
Centre/Hospitai
according
to
prescribed
curriculum. They will also receive field orientation as
a continuous process to be arranged by the organisation
in consu. 1 ta 11 on with the Directorate of Family Welfare
of State.
V)
A
spirit of healthy competition among the workers
and
the members of the target community will be postered by
instituting gifts/rewards to the best workers
selected
under
the
project and to the best
mother,
mother,
the bestcouple
and
the
most nealthy child
selected
in
the
se1ected
in
project area.
5
\ )
I
VI )
8.
The annual get-together' of the eligible couples in the
area will be he 1d for d i s t r i bu t i. on o f the prizes, This
occas1on
will
be
utilised
for'
a
free
and
f rank
exchange of views i n regard to the Family Welfare‘
and
MCH programme in the area.
A)though
funds have
been
provided
in
the
scheme
for'
this
function,
the
imp1 emen ting
organisation may raise iifioney from
<other'
sources such as corporate Bodies to enable
themse1ves
to
f ind
adequate
funds
for'
organising
the
gettogether.
Project Period:
mini mu.m
The
minimum
period of each project sanctioned
under
the
scheme will be three year's. Each project will be
sub jected
to
a
mid-term
evaluation by the
Ministry and
a
f i na 1
evaluation
by an External Agency at the end of
the
three
years period and based thereon a decision will be taken
to
discontinue financing the project or to extend as the case
may
e.
9.
ANNUAL FINANCIAL IMPLICATION ;
A.
Staff
( i )
Kini Family Welfare Centre
Unit Coordinator (Full-time Employee)
on Salary
Rs.
Conveyance allowance
Rs.
F'os t age / Con t i ngency
Rs.
1O00/—pm
50/—pm
50/-pm
1lO0/-pm
Fer annum
(n)
Rs. 13,200/Field Unit
Sahel les
-5
Extra honorarium for Group leader
Total
Per annum
< i i i )
B.
C.
= Rs.
Rs.
Rs.
:
10O/—pm
75/-pm
575/~pm
6,9O0/-
Annual Expenditure
Recurring
- Salary of the staff of Mini
Family
Welfare Centre = Rs. 13,200/5 Field Un its @ Rs. 0,900/per Unit
= Rs. 34,500/-
Administrative Support cost to
Voluntary Organisation
Rs. 250/-pm
Building rent
Rs. 250/—pm per' project
con t i ngenc ies
Non—recurring expenditure
Furniture and educational aid
Training of Unit Coordinator and Sahel les
Sub-total
- RS.
7000/-
6
Rs.
Rs.
Rs.
30OO/3000/20OG/-
Rs.
Rs.
2000/5000/“
D.
Prizes & Annual Get-together
Pri zes
i )
Best Saheli Prize
First Prize
Second Prize
Rs.
Rs.
500/250/-
Best Group Leader Prize
F i r s t Prize
Second Prize
Rs.
Rs.
700/350/-
Best Mother Prize
Rs.
400/-
1 v)
Best eligible couple prize
Rs.
400/-
v)
Most Healthy Child Prize
Rs.
400/-
Total prizes
Rs.
Rs.
3000/1OOO/-
Total
Rs.
4000/-
11 >
Annua 1 Get-together Function
GRAND
TOTAL FOR THE PROJECT
Rs.
66,700 per annum
10.
Unit Coordinator/Group Leader/Sahel i
(a)
The Unit
Coordinator will coordinate and
supervise
the
project
and
keep a regular liaison with
the
field
unit,
She/He
will spend one day each with 5 units and will be
at
headquarter on the 6th day. She/He will maintain records and
monitor the whole project, and undertake correspondence.
Unit coordinator will be a full time employee and primarily
Extension Educators and will be required to develop rapport
with the Primary Health Centres, Sub-Divisional
Sub—Divis ional
Hospitals,
Family
Welfare Centres
and
Voluntary
Organisations,
Hospitals/Clinics where
he will be required to
send
the
motivated persons.
In case of male unit
coordinator,
he
will also try to motivate the men in his areas for adopting
a small
family norm and terminal and spacing
methods
of
family Planning.
Unit
coordinator
will have a degree in Science
or
Social
Science and Biology from a recognised University. Preference
will
be
given to persons having two
years
experience
in
health care/fami 1 y planning activities.
(b)
Group Leader
Group leader will primarily be a Sahe1i but she would
a 1 so
be given
an
additional
responsibi1ity
to
assist
the
Sahe1ies
and
act as Group leader of the
will
Unit.
She
estab 1ish
rapport
with the Primary
Health
Centre.
Sub —
Divisional
Hospital
and
other
Hospitals/Clinics
and
maintain
basic
records
to be passed
over
to
the
Un 11
Coordinator.
She
will
help to develop
a
programme
for
motivation
of women in reproductive age group for a
small
family norm.
She
will
extend
support
to
sahe1i es
by
visiting
family
etc. She will ensure
that
wel1—designed
Family Cards are maintained by the Sahelies for each of the
target family in her Field Unit.
7
(c)
Sahe1i
There will be one Saheli for a population of 1,000 in
u roan
are ■»
and 6O0 in rural area. The Saheli will be
opte^d
T rum
t h u Anganwadi
Workers/Ba 1wari Workers ,or
ins t rue tors
other'
Child Survival Scheme from the units located
in
t r. e
area
of
operation of the project. The
lady
T rOili
workers
commonity can also be appointed as Saheli (i) if above named
workers
are not willing (ii) due to special requirement
of
the
segment
of
population
to
be
served.
Besides
the
honorarium of Rs. 100/—pm motivational and
other
benefits
for sterilisation and IUD cases will be admissible
to
the
Saheli
in addition in accordance with the rates
preset' ibed
by the respective State Governments.
1 1.
Monitoring and Evaluation
11.1
The monitoring will be done each quarter at the level of PhC
in
>'ural
set ijd and at District 1 eve 1 i n
city
set-up
oy
M.U.,
PHC/CMO
respectively
in
their
regu1a r
meetings.
Project
Manager will present the report regarding tne
work
of the Centre under various heads 1i ke :-
1
•T
4
5
~1
Referral Cases.
MCH Work
Mot ivat ion
House visits
Educational FTogramme
Training Programme
Area Profile
11.2 There
will be a mid-term evaluation of the project
by
r he
Ministry.
The final evaluation will be done by an
E :< t e r n a 1
Agency at the end of the three year period.
12.
Release of Funds
Release
of funds will be under the Central
Sector
Schemes
for grant-in-aid to Voluntary Organisations. The amount
of
Rs.66,700/for meeting the cost of implementation
of
the
scheme
curing
the first year period will be
paid
in
two
installments. The first installment for the six months
will
consist
of
full
non-recurring
expenditure
and
5O7.
of
recurring expenditure. The second installment will be
g i ven
when the project starts operating after completion of
three
months of the project life on receipt of the progress repor t
and expenditure statement for the first quarter,
Gran t-in —
aid for the second year of the project will also be released
in two installments, the first installment at the Ibeginning
of
the
second
year'
of
the
project,
and1
the
second
installment
after
the mid-term
eva1uation
and
will
be
subject
to production of audited statement of: accounts
for
the
last
year by
the organisation,
The
th i rd
year-*
installment
will
also be in two parts with a1
gap
of
s i :<
months.
1The
he
second part will be subject to
production
audited
statement of accounts by' the organisation
for
the
last year'.
K /
^7.
APPLICATION PROFORMA FOR APPLYING GRANT-IN-AID ASSISTANCE
UNDER THE MODEL SCHEME ’MINI FAMILY WELFARE CENTRES'.
Name? of
( i )
( i i ?
the organisat1 on
1.
Name of
2.
Registered Address
3.
Registration No.
(with Act/Statute under
which registered?
4.
Financial Status of the organisation
\ 1 )
‘.11)
Total income during
year ended..
the
Rs.
To t a 1 Expenditure during the
year ended
..
Rs.
(ill)Total Assets during the
year ended
I!
Rs.
5.
Details of Hea1 th/Fami1y Welfare
Infrastructure presently available
with the Organisation.
6.
Hea1th/Fami1y Welfare Workers
presently in employment
7.
Previous activities of the
Organisation, especially in
relation of family welfare.
8.
Amount of Grant-in-aid
requested Item wise
9.
Duration of project.
I
10.
P rosiden t
Hony. Secretary
Project Area :
Urban
FULL TIME
<i)
( i i)
PART TIME
Recurring
Non—recurring
<i)
Name of City/town V. District
(ii)
Name of
Mohallas/Number
of
Municipal
their
Wards,
with
covered
populat ion,
to
be
under the project.
( iii)Name
of
Mohallas/Number
of
Municipal Wards to be included
in each field unit.
( i v)
Location/address of each field
un i t
(v>
Location/address of MFWC
9
/
Rural
(i >
(11)
Name of Block
District
Names of Villages, with
tneir
populations,
to
be
covered
under the project.
(iii)Names of Villages, with
their
populations, to be included in
each field unit.
< iv)
Location/address of each
un 11.
(v)
Location/address of MFWC
1 1.
Population of
Project Area
12.
Total Number of eligible
Couples/women/chiIdren(0-6 yrs.)
in the project population
13.
Source from whicn information
against column 12 above has
been taken.
14.
Name of PHC/Hospita1/Dispansary
Which
will
provide
MCH
immunisation.
Oral Pills
and
Family Welfare Services.
15.
Methodo 1ogy
to
be
ach ievi ng
the
ob jec11ves,
(refer
5-6 of scheme)
16.
Target to be achieved.
(please
specify number
of
eligib le
couples,
women
&
chi1dren
(0-6 yrs.)
expected
to benefit under the project)
17.
Whether
the
Organisation
is
a1 ready
running
any
scheme
under Family Welfare Programme
with
assistance
from
State
Govt./Government of India.
the
Number
(n) Economic Status
dii/Literacy Status
Attitude towards
(a) Small Family Norm
(b) Meh/Immunisation
( i)
used
stated
to
para
10
field
/
IB.
<a)
Are ICDS/taIwadi/Creche
/Chi Id
Surviva1
func tion i ng
i n the
a r ea
o t project.
(b)
I f answer to 18u)
above
yes ' p1 ease sstate the
number
of
workers
from
these
Ba 1 wad is/
arganwadis/creches
to
p a r 11cip a t e
in
the
is
pt'O jec t.
•c)
19.
Number
of Sahel is to
be
associated
from
the
genera1
target
area./commun i ty.
Any
other
in formation.
re 1evan t
Signature
(with stamp)
I
■j
1 1
I
Annexure
LIST OF DISTRICTS HAVING COUPLE PROTECTION
RATES LESS THAN 207. AS ON 31/03/198?
S.No.
States
1.
Assam
District
N.C.Hi 1 Is
Son i tpu.r
3. Darrang
4. Cachar
Dhub ri
6. Na 1bari
7. K.Ang1ong
8. Kar imgan j
9. Barpeta
10.Kokrajhar
18. 9
18. 8
18. 7
14.5
13.9
10.8
10.7
9.6
9. 1
6. 1
S i wan
Munger
3. Gopalganj
4. Bhagalpur
5. Pa1amu
6. Samastipur
17.8
17.9
19. 4
19.7
19. 8
19. 9
Kupwara
Doda
3 . Kargi 1
4. Badgam
5. Poonch
6. BaramuIla
7. Kathua
8. Udhampu.r
9. Rajour i
9. 2
11.9
12.0
12.3
15.3
16.2
16.8
17.5
19.3
1.
o
1 .
Bihar
'-y
4
I
1.
3.
Jammu
4.
Rajasthan
1.
2.
Barmer
Jaisa1mer
15. 4
19.8
5.
West Bengal
1.
Ma 1dah
19. 1
Kashmir
• i
I
CPR as on
31/03/89
•i
i
f
1I
I
12
I
/
?/■
VI. SCHEME FOR EXPERIMENTAL INNOVATIVE PROJECTS
UNDER FAMILY WELFARE PROGRAMME
Financial assistance can be provided for projects not confoiming to any particular pattern
but which are viable and aim to provide motivation, communication, educational activities and
services, or are otherwise innovative in nature in the field of Family Welfare. Because of the
nature of the schemes, proposals have to be prepared by the NGO’s themselves keeping in mind
their own objectives and capabilities. Essential components of the scheme include a baseline sur
vey and end of project survey to evaluate the impact of the scheme. Financial assistance will be
provided for such survey as also for such components as training (where necessary) moti\ational
activities, services for Family Planning, MCH staffing etc. Assistance for supply of Family
Planning equipment like laparoscopes, IUD, Oral Pills, Condoms, etc. could also be provided
in cash and kind. Supply of Family Planning Services like Oral Pills, Condoms, IUD, could be
arranged with State Governments and Union Territories.
The project should preferably serve rural areas, urban slums taking into consideration the
facilities already available with the NGO/State Govemment/Union Territories in the area. There
is no bar to utilising services delivery facilities already in existence whether belonging to Govern
ment or Private agencies.
A provision of Rs. 7 crores exists in the 7th Plan for this Scheme and those mentioned at
S. Nos. VII and X.
Procedure for submission of Application:
There is no prescribed application form for submitting a proposal for grant-in-aid under this
scheme. However, besides the details of the proposed project, the following documents/information are required to be furnished by the Voluntary Organisations for considering their request
for financial'Sssistance:—
1.
Whether the organisation has been registered under the Societies Registration Act,
1860, if so, a copy of the Constitution of it with the Memorandum and Articles of the
Organisation alongwith a list of members of the Managing Committee.
2.
Certified copies of the audited statements of accounts for the last three years.
3.
Annual Report or other documents giving details of activities of the organisation,
especially in relation to family welfare programme.
4.
Whether the organisation is receiving any assistance from other Departments of the
Central Government or State Government for Family Welfare Programme or any other
scheme.
5.
A copy of the repo rts of the previous activities.
The application should be submitted to Under Secretary (OS), Ministry of Health & Family' f
Welfare, New Delhi-110011 in duplicate and a copy of it may be sent to the Family Welfare De
partment of the StateGovcmment concerned for onward trans mission to the Government of India
with their comments/recommendations.
/
VII. MCH & IMMUNISATION PERFORMANCE LINKED MODEL FCR
ASSISTANCE TO VGLLNTARY ORGANISATIONS IN
URBAN AREAS
Background
This mxie! is applicable io a population of 25.000 in un-served or under-served urban
areas and particularly slums and urban fringes in towns/ cities with a population of ’css than 2
lakhs. The events and activities have been identified on the basis of population range of 25.000
for 100 ’o coverage in MCH and Immunisation activities and 20% annual coverage" in family
welfare services. This favourably compares with the D-type urban family welfare centres which
covers a population of 50,000 but the performance level is about 50%. Therefore, in terms of
the performance this unit can be treated as equivalent to type D urban family welfare centre.
StaiT Requirement
The optimum level of stall required to render the services outlined in this project is indi
cated in the Annexurc-I. This is necessary to maintain the professional level of performance
of MCH and Immunisation services. The Voluntary Organisations will have to keep the staff,
as indicated in this Annexure. The Voluntary Organisations will however, have flexibility in the
matter of appointment of the staff on part time or full time basis as suitable for the proper func
tioning of the project and can even engage staff for fixed hours. The Voluntary Organisations
will also have flexibility in terms of the emoluments to be sanctioned to staff subject to the Mini
mum Wages Act Rules applicable in this regard.
1.
ELIGIBILITY
(1) An urban area chosen should have population of 25,000.
for consideration for assistance.
This population is a unit
(2) The area should be such that it is not being served by any existing urban family wel-
fare centre or is under-served.
(3) The population living in the area should be of low socio-economic status.
II.
Regimen and norm of paymeat for MCH and Immunrsation Services
*A & D-l Children Services
Payment norm by
regimen (Rs.)
(i) DPT (3 shots)
2,3,5
GO BCG
2
(iii) Polio
2,3,5
(iv) Measles
2
(v) Maintenance of Growth Chart
2
♦B 1—5 Children
(i) DT (2 shots)
2,2
(ii) Vit. ‘A*
2,2
(iii) Iron and Folic Acid (3 times)
2,2,2
)
23
*C Pregnant Women
5,5
(i) T.T. (2 shots)
(ii) Urine examination (3 times)
2,2,2
(iii) Haemoglobine
222
(iv) BP
222
(v) Weight
n
,,
222
(vi) Iron & Folic Acid
10
(vii) Delivery
I
10
(viii) Post-natal care
♦Note : _ Wherever, the activity is to be completed in two or more stages, the pay
ments for first/sceond stages (will only be admissible) after all stages are
completed. No payment will be permitted for incomplete activity.
Family Planning
The family planning activity to be promoted by the organisation would primarily be in
the following sectors
(i) Motivation of the eligible couple for a smaller family norm and adoption of a family
planning technique acceptable to them,
(ii) The sterilisation operation tubectomy/vasectomy will be undertaken at the recog
nised centre being run by the Voluntary Organisations, Primary Health Centres or
Govemment/Local body hospitals which have been authorised to undertake this
work.
(iii) The IUD work for this unit will include both motivation and insertion and followup.
(iv) The distribution of the oral pills will be done by ANM after filling the check list. But
the acceptor will be got examined from the medical doctor within three months. The
payment will only be admissible after 12 months continuous use (13 cycles) by the
acceptor.
(v) Nirodh Supply
It has be to ensured that there would be 6 months continuous use and
payment will only be admissible after the expiry of the 6 months period.
(vi) The incentive for the motivation both for sterilisation and IUD insertion will have to
be claimed by the Voluntary Organisations from the State Governments as per
pattern prescribed by them.
(vii) The claim for sterilisation operation will be as per pattern laid by State Government
for private practitioners
(Rs.)
Family Planning Activities
(i) Sterilisation (motivation)
(ii) Sterilisation (service)
(iii) I.U.D. Insertion
1I
Claim for these to be made from the
State Government as explained above.
I
J’
(iv) Nirodh (six months of continuous use)
10 per case.
(v) Oral Pills (for 13 continued cycles).
25 per case.
3107 IUFW/89—
III. Target No. of events in the population (25,000)
Events
Number
(i) Births
(ii) Pregnant women
800 (32/1000 birth rate)
880
(iii) Deliveries
800
(iv) Post-natal care
800
(v) Children (1—6 years age)
(vi) Eligible women
3250 (13% of the population)
4250 (170 per 1000 population)
(vii) Distribution of women by numbe r of
children ever bom%
Number
zo
l
0
10.5
446
I
11.0
468
2
11.0
468
3
11.0
468
4+
56.5
2401
IV. Total Cost for Total coverage (Immunisation
1. D-l Children
and MCH)
No. of
x cost per
events
service
Total
Rs.
DPT
800
x 10
BCG
8000
800
x 2
1600
800
x 10
Measles
8000
800
x 2
Maintenance of growth chart
1600
800
x 2
1600
Polio
Sub-total
2. 1—6 Children
DT
Vit. 4A’
Iron & Folic Acid
20000
813
3250 ?
800=1613 x 4
4
6452
1613 x 4
6452
1613 x 6
9678
Sub-total
22582
3. Pregnant Women
TT
Urine Examination .
Hb
BP
840 x 10
8400
840 x 6 =5040
840 x 6 -5040
840 x 6
5040
cost
I
Weight
Iron and Folic Acid .
840 x 6 -5040
840 x 6 =5040
Delivery .
800 x 10 =8000
Post-natal care
800 x 10 =8000
Sub Total
49600
4. Family Planning
Nirodh
4113
Oral Pill .
2285
Sub-total
6398
Cost MCH
FP
93082
6398
99480
Or Rs. 99500
V.
This total cost is comparable to the standard pattern approved by the Government of India
for D type Urban Family Welfare Centre.
Release of funds
Release ol funds will be made under the Central Sector Schemes for grant-in-aid to Voluntary Orgamsations. An amount of Rs. 99,500/- has been computed to be admissible to each
Voluntary Organisation for the activities, events identified in this project. An advance for the
contingent and non-recurring expenses will be paid in the first instance for procuring equip
ment. Later to meet the other recurring expenses adx-anco will become due on quarterly/sixmonthly basis as may be decided.
Voluntary tlrganisations will get the amount specified for each activity under the three
heads identified in the project viz. MCH, Immunisation and Family Planning Services. These
rates have been worked out after taking into consideration the anticipated scales of salarv con
tingencies and non-recurring expenses on equipments. The Voluntary Organisation will get
charges in terms of the rates prescribed for each activity. Grants will be admissible only when
the full staffis employed on the project. The amount of Rs. 99,500/- per year has been worked
out to cover the expenditure on the suggested activities.
Evaluation:
Periodical evaluation of the project would be necessary to draw up the necessary feed back
and make modifications, if necessary, in the scheme. Effort will be made to arrange the evalua
tion through reputable organisations in the field who could make frank and independent
assessment.
ANNEXURE —I
1. Staff
No.
Part-time Medical Officer (lady)
LHV
ANMs
....
f emale Helpers
.
1
.
1
2
2
Clerk-cuin-Coinpounder .
Sweeper
I
1
2. Non-Recurring
Equipment
rs. 12000/-
Refrigerator
rs. 5000/-
Fumiture
Rs. 5000/-
3. Contingencies
r$. 20000/-
4. Overheads (15%)
Rs. 17820/-
The application should be submitted to Under Secretary (OS/Desk Officer (SCOVA),
Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi-110011 in duplicate and a
copy of it may also be sent to Director of Family Wclfareof the State Government concerned.
Ill
ACTION PLAN FOR REVAMPING THE FAMILY
WELFARE PROGRAMME IN INDIA
1.
F
DEMOGRAPHIC SCENARIO
1.1
According to 1991 Census,the country's population is 843. 93 milliona substantial rise from 342 million in 1947 and 684 million in 1981. The
annual addition to the population is 16 million. The all-In di a average
annual growth rate during the 1981-91 decade has been of the order of
2.11%-marginally lower than 2.22% during the preceding decade. The
Statement at Annexe-I brings out the comparative position in regard to
decadal variation in _population,
change in I decadal
_
averagevariation and
exponential growth rate of population in different States/UTs.
1.2
The latest available Sample Registration System (1989) estimates
indicate All-In di a birth rate of .30.6, death rate of 10.3 and Infant
Mortality Rate of 91. Two important parameters' influencing fertility
behaviour are female literacy and age at marriage for -women. Couple
Protection Rate (CPR) also indicates the level of efforts made for birth
control. The Statement at Annexe-II brings out the comparative position
of different States/UTs in regard to several selected indicators.
1.3
The long term demographic goals as laid down by the National
Health Policy (1983) is to achieve the birth rate of 21 per thousand,
death rate of 9 per thousand, natural growth rate of 1.2%, infant
mortality rate below 60 per thousand live births and couple protection
rate of 60% by the year 2000 A.D. It has already been recognised that
given the current level of achievements,
the goals may not be
achieveable at the National level before 2006-2011 A.D.
2.
FUTURE STRATEGIES
Faced with grim prospects of population explosion, it is necessary
to devise innovative strategies for imparting new dynamism to the Family
Welfare Programme. While the population control programme has to
essentially evolve as a multi-sectoral programme comprising many
aspects which go beyond family planning, a result-oriented Action Plan
has been developed. The broad
‘----- d fframework
------------ 1- is summarised below:2.1
National Consensus and Efforts
The population control programme should emerge as a national
consensus with willing participation of all segments of the society
cutting across political, religious and cultural barriers. It has to be
backed by strong political commitment and will not only at the national
level but also at the level of States/UTs, which are primarily
responsible for implementation of the programme. Political leaders,
religious leaders and other opinion leaders at different levels will have
to be approached for their active involvement in moulding public
opinion.
2.2
Improvement of quality and outreach of services
A vast network of institutions has come up in the country for
delivery of health and family welfare services over the successive plan
periods. It has, however, been recognised that the quality of service
delivery extended to the people is not satisfactory. Besides, the
outreach of services is also not adequate for the people ini remote rural
areas and urban slums. The following steps would be taken:-
peeping in view the general’ constraint of resources (financial,
a)
administrative
and managerial)
for pushing the family welfare
programme, the thrust during the Sth
8th Five Year Plan would be first to
consolidate the existing infrastructure. There is no point in going for
opening of new sub-centres etc. in the future, if the existing
sub-centres are not functioning properly. However, keeping in view the
norms fixed during the 7th Five Year Plan, new institutions will be
sanctioned if adequate, funds are made available. Special attention will
be paid to creation and strengthening of infrastructure in the urban
slums where these are particularly deficient.
b)
Integrated training modules for training and re-training of medical
and para-medical personnel involved in the delivery of family welfare
services
will _ be developed and adequate funds made available for
CCS will
organising different training programmes in the institutions alreadv set
up for the purpose.
As motivation is a ]key factor in imoroving the quality of delivery
c)
of services, it will form a 1key _1
element in the training modules for
medical and para-medical personnel at all levels.
d)
Special
attention shall be paid by the State Govts./UT
Administrations to have a proper organisation for maintenance of
equipments, vehicles and buildings and, wherever possible, train even
the existing family welfare workers for doing small repairs. This would
ensure proper
j
utilisation of vital equipments and valuable assets created
under the programme.
e)
The supervision at all levels will have to be vastly improved, This
will primarily focus
on identification of problems, finding solutions
rthereto
and improving
------- o
understanding and capabilities of key
functionaries involved in the delivery of services.
f)
Special attention shall be paid to the construction of buildings for
nmary Health Centres and sub-centres through Area Development
rro]ects and under the Minimum Needs Programme of the States Plans.
g)
The State Govts, and UT Administrations would look into the
practical problems of the workers like ANMs in the field conditions such
as their place of stay, mobility and travelling expenses etc. as
inadequate attention to these problems seriously hampers the working of
t e main propagators and service providers of the family welfare
programme at the grass root level.
2
2.3
n
Special Strategy for 90 Districts'
The demographic and health profile of the country is not uniform.
Examination of the statewise data regarding behaviour of the important
demographic and health indicators shows very clearly that any
operational strategy, to be successful, will have to be based on
disaggregated approach. The 4 States of Bihar, Madhya Pradesh,
Rajasthan and if.P. which constitute about 40% of country's population,
have IMR and MMR level
distinctly higher than the national average.
These are also the States where female age at marriage, female literacy
and share of women in the non-agricultural employment are distinctly
lower than the national average. Unless special efforts are made to
bring up the profile and performance of these States in regard to
health and family welfare, it toould be well-nigh importance to accelerate
the achievement of demographic and family welfare goals at the national
level. Special Area Development Projects have already been launched in
these States with the help of World Bank, UNFPA and other funding
agencies. The pace of the implementation^ of these projects primarily
designed to strengthen the infrastructure and to improve the training
of their staff requires to be speeded up with due attention to quality of
implementation.
at
2. 3.1 The relevance of the disaggregated approach does not stop
analysis
of
demographic
the identification of the four States. An
indicators at 1the district level indicates that there are 90 particularly
bad districts where the CBR is above 39 per thousand (1981 Census).
A list of these districts is placed at Annexe-Ill. The following steps
would need to be taken to improve the programme performance in these
districts:a)
Micro-level planning by the States to identify the needs on a
a)
realistic basis for reduction in birth rate in these districts. Resources
will be> allocated for strengthening of infrastructure and provision of
other essential inputs after taking into account the inputs already
provided in these districts through Area Development Projects and other
special projects, if any.
L)
All posts at grass root level of family welfare workers and
b)
supervisory officers would be filled up and only motivated officers with
excellent record in these districts would be posted.
Priority for construction of sub-centres and buildings for other
c)
health institutions would be given in these districts under the Area
Development Projects.
d)
Intensive training of medical and para-medical personnel would be
organised.
el
Since many of the low performance districts have large minority
populations,
minority community leaders at local levels would be
involved in launching imaginative IEC programmes designed to increase
family planning acceptance by all sections of the society through
methods best suited to individual needs.
f)
In order to improve the inter-personal communication efforts at the
3
grass root level, a scheme of link volunteers would be tried out in some
of the districts on a pilot basis. Deptt. of Woman and Child
Development would be requested to cover all the 90 districts with ICDS
programme and suitable linkages developed at the delivery level with
ICDS functionaries to delivery health, nutrition and family welfare
services as a package.
g)
The
District
Collectors
would
be
fully
involved
in
coordination/supervision of family welfare programme related activities in
these districts.
2.4
Package of Incentives/Disincentives
2.4.1 The present scheme of compensation for loss of wages to
acceptors of sterilisation/IUD,
places
great emphasis on target
achievement with the result that the quantity has taken precedence over
quality and some specific methods seem to have over-shadowed others.
It has increasingly been recognised that we should get .rid of "tyranny
of targets" altogether. Targets based on micro-level planning suiting
the local specific needs may, however, continue to be fixed for
monitoring of the programme.
2.4.2 The above scheme will be modified to provide for greater
flexibility to the States and to cover younger age couples with greater
fertility potential under spacing methods. The resources meant for the
purpose would be provided to the States/UTs in relation to their overall
birth rate reduction efforts. In order to work out a suitable formula for
devolution of resources under the scheme, a Committee under the
chairmanship of Shri S.B. Mishra, Joint Secretary in the Ministry of
Health 6 Family Welfare will be constituted which will have 4 State
Health Secretaries as its members-two from good performing States and
two from poor performing States. The Committee will finalise its
recommendations within 3 months of its constitution.
2.4.3
No more incentive to Govt. , employees will be considered. A
suitable package of disincentives will be developed for this section of
the society for adoption by the State Govts, as well, It will also be
recommended to the employers in the organised sector.
2. 4. 4 Motivators fee etc. presently being paid to service providers will
not be paid any more as it also leads to emphasis on achievement of
specific methods of contraception.
be
scrapped
2. 4. 5 States
Award
Scheme * already
decided
to
retrospectively w.e.f. the financial year 1988-89, would not be revived
as it had been leading to falsification of figures and unhealthy
competition. However, suitable incentives to encourage good performance
shall be built in the proposed modified scheme of compensation.
2.4.6 An innovative package of incentives/disincentives would be
formulated with emphasis on community based incentives and social
security measures for individuals adopting small family norm. The
community based incentives would be linked to various benefits being
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made available to the public under different socio-economic development
plans of the Government.
2.5
Promotion of Different Contraceptive Methods/Devices
2.5.1 Sterilisation procedures were the mainstay of the programme in
the past. However, acceptors have generally been the higher age and
the high parity couples who have already completed the desired family
size. The contribution of sterilisation to the fertility decline, therefore,
has been less than anticipated. While sterilisation would continue to play
an important role in the population control efforts, it would be ensured
that the profile of the acceptors would be of the right quality in terms
of age and number of-children already born.
2.5.2 Spacing methods will be vigorously pushed for adoption by the
younger age couples with high fertility potential. This would require
good follow up services for acceptors of IUD insertions to bring down
the drop out rates, improvement in the distribution arrangements of
conventional contraceptives and oral pills in rural areas and urban
slums through strengthening of schemes, -for social marketing of
contraceptives and launching of community based distribution of
contraceptives. The free distribution schemes which are somewhat
wastage-prone would be gradually curtailed and limited only to such
areas where these are actually needed for economic reasons or for lack
of
outreach
of social
marketing/community
based
distribution
programmes.
2.5.3 The quality of contraceptives would be improved. In this regard
supply of dry condoms under the free distribution scheme would be
gradually phased out and only lubricated condoms made available.
2.5.4 The production arrangements for weekly oral pills (Centchroman)
and oral contraceptive pills (Mala N and Mala D) shall be gradually
improved so as to make these easily available across the length and
breadth of the country in greater numbers.
2.5.5 In order to give a wider choice of contraceptives to the
acceptors, new contraceptives such as Norplant-6 and injectibles shall
be introduced under the programme, initially under controlled conditions
and gradually on a wider scale.
2.6- Universal Immunisation Programme and MCH Programme
2’. 6.1 Consistently high coverages are being now reported from most of
the States in the UIP. However, there still remain areas where the
coverage levels 'are low. Special attention would be focussed on such
areas during’ the coming years,
while sustaining the high level of
coverage achieved elsewhere.
2.6.2 All such cases where reported coverages are more than 100% of
the’ target fixed, the reasons for high coverages would be routinely
investigated to ensure that no over-reporting is allowed as this would
otherwise lead to a sense of complacency leading to outbreak of the
vaccine preventable diseases.
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2.6.3 The C'
ultimate objective being reduction of vaccine preventable
diseases, the priority in the coming years would be to concentrate on
the quality aspects of the services delivery and on documenting
reduction in disease incidence. The following activities in this context
would be strengthened:a)
Initiate active surveillance in areas where low incidence has been
recorded in the last two years. List of cases, particularly of Polio and
neo-natal tetanus would be the lead diseases under monitoring.
b)
Set. up network of Polio Virus Isolation Laboratories while
increasing the" number of. field samples of Oral Polio Vaccine to ensure
that atleast one full sample is lifted from every Primary Health Centre
area in a year.
c)
Time-bound
vaccination.
investigation
of
all
adverse
reactions
}
following
2.6.4 For overall improvement in the management of the programme, -all
supervisory posts created so far particularly that of the District
Immunisation Officers and Refrigeration Mechanics would be-filled up by
the States/UTs.
2.6.5 All States/UTs would also take priority action to take over the
maintenance of the cold-chain created over the last 4-5 years and
further planned to be strengthened in the coming years.
2.6.6 About 1.5 million children below 5 years of age die because of
Diarrhoea in the country every year. Even though the Oral Rehydration
Therapy Programme is being implemented for quite some time now, it
has met with only partial success. There are still many medical
practitioners who are not propagating it or prescribing ORS. The
programme would be more vigorously promoted through the training of
medical and para-medical personnel and through health education to
people, particularly mothers.
2^6.7 Keeping in view the
Health xor
for ail
All goal by
2000 A.D. a new
x..u./
Liie neaun
Dy zUUU
Child Survival and Safe Motherhood Programme is proposed to be
implemented with IDA/UNICEF assistance in a phased manner. It would
provide for universalisation of IFA to cover all pregnant mothers,
universalisation of Vit. 'A1 to all children upto the age of 3 years,
expanding the pilot project on control of Acute Respiratory Infections
and strengthening primary health care infrastructure coupled with an
intensified training of traditional birth attendants in the higher
IMR/MMR States of Assam, Bihar, Orissa, Madhya Pradesh, Rajasthan
and U.P. it is expected that this Project would not only help in
lowering the IMR/MMR and child mortality rate but would also contribute
significantly to improve the family welfare services.
2.7
Urban Area Schemes
2. 7.1 The Schemes like Post-Partum Centres, Urban Family Welfare
Centres, Health Posts are designed to provide Family Planning and
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Maternal and Child Health Care services to population living in the
urban areas including slum areas. While the post-partum centres have
generally become hospital based programmes and are not effectively
catering to the areas/populations attached to them, the quality and
outreach of services being provided by the Urban Family Welfare
Centres/Health Posts are also not satisfactory. This has resulted in a
situation in which the F.P. and MCH services are not effectively
reaching the urban slums population which is an area of major concern.
The following steps would be initiated:-
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a)
With a view to strengthen infrastructure and services, Urban
Revamping Schemes covering towns with
lakh population and above
with special focus on slum areas are already being developed. The
operationalisation of these schemes would be expedited with adequate
funding support from central budget and external agencies.
b)
The involvement of voluntary organisations in catering to the
needs of slum population will be enhanced. Preference would be given
to voluntary groups already active in such areas.
C)
The urban institutions whether under the Government or in the
voluntary sector will be closed down or shifted elsewhere in case an
optimum level of performance is not recorded. It would be ensured
through proper monitoring and supervision mechanisms that these
institutions do seriously endeavour to meet the respective programme
objectives, particularly those related to serving the target population
assigned to each. Adequate flexibility would be given to States/UTs to
meet these objectives.
d)
Suitable coordinating mechanisms would be developed to ensure
that the urban institutions function in an integrated manner and not in
total isolation of each other and the overall programme objectives.
•)
2.8
• Village Health Guide Scheme
There - is a general impression that this important scheme
designed to provide for the basic linkage between the community and
the Health 8 Family Welfare service delivery system, is not working
well. VHGs are presently getting only Rs. 50/- p.m. as honorarium and
in most parts of the country, they are not rendering much service to
the community. Some States (J. 8 K., Tamil Nadu, Kerala) did not
implement the scheme from the very beginning and some others like
Assam and Haryana have scrapped it. The decision to replace male
health guides'with female health guides has also led to a plethora of
writ-petitions in different High Courts. The general experience has
been that wherever female health guides are in position, the ground
situation of service delivery is much better.
2.8.1
The following steps would be taken
a)
All the pending court cases would be effectively followed up and
got decided on a priority basis.
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b)
The existing number of Village Health Guides shall be fully
utilised by States/UTs with reduced functions, if necessary. Their
services may primarily be utilised as motivators and depot-holders for
contraceptives, Oral Rehydration Salts, IFA tablets etc.
C)
The possibility of revitalisation of the scheme to make it more
effective or alternatively of disbanding it would be examined further
taking into account the varied implications including from the legal
angle.
2.9
Continuation of ANM/LHV Training Schools
There are a large number of ANM/LHV/MPW (M) Training Schools
in different parts of the country. As regards ANM/LHV training, many
States/UTs have already fulfilled targets of recruitment and basic
training of workers. In so far as the scheme of training of Health
Worker (Male) is concerned, most States have stopped training as fresh
recruitment is not "taking place. There is a large number of vacancies of
MPW (M) in different States/UTs which has caused serious concern.
2. 9.1
The following steps would be taken
a)
The existing infrastructure of ANM/LHV Training'Schools would be
thoroughly reviewed for each State/UT to ensure its proper and
effective utilisation. Schools without buildings and those being run
through voluntary organisations shall be closed down gradually. The
remaining schools will be utilised for running integrated training
modules for para-medical workers, including of voluntary sector, and
for continuing education programmes.
b)
States/UTs would initiate action to create posts of MPW(M) to meet
the existing gaps in a phased manner and effectively utilise the
available training infrastructure.
c)
Net working arrangements of training institutions at different levels
would be developed with a view to ensure uniformity in training
modules, avoid duplication and bring about effective coordination.
2.10
Information, Education, Communication
Information, Education and Communication (IEC) inputs need to
be revitalised not only to propagate the Family Welfare Programme but
also to bring about attitudinal changes so as to cover a part of the
ground which should be normally prepared through education and social
work. The new IEC strategy would have the following key elements:a)
The IEC message would be to associate Family Welfare with planned
parenthood and not just with the adoption of contraception.
b)
The messages would be positive with thrust on quality of life issues
and removal of ignorance. apathy and misgivings about the Family
Welfare Programmes.
c)
In order to involve the community in generating demand for Family'
Welfare services, the Scheme of Mahila Swasthya Sangh which has been
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9rrecently introduced in some selected districts would be
strengthened in case the results are found to be encouraging.
further
d)
The messages through the Mass Media would be of a balanced nature
so that these do not harm sensibility in our socio-cultural ethos.
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e)
In order to cover 40% of the population which is not covered by any
mass media presently, special attention shall be paid on traditional art
forms,
folk-lore,
field publicity and inter-personal communication,
Feature films with entertainment value would be developed for being
shown on 16 mm projectors for conv-eying the required messages in a
suitable manner.
f)
Increased emphasis would be laid on development of media
material in a decentralised manner so that these are produced taking
into account the regional diversities in the country and locah specific
needs.
g)
Regular training of IEC staff at different levels would be
undertaken to expose them to latest IEC techniques, improving their
motivation and administrative/managerial abilities.
i
h)
The funds provided for media activity would be in no case
diverted as is happening in some States presently. The importance of
IEC activities in achieving the desired goals would need to be fully
realised by the States/UTs.
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IEC efforts would increasingly focus on the need for participation of
males in adopting contraception with a view to remove misgivings about
the vasectomy, which is a much simpler procedure than the female
sterilisation.
1)
The Rajasthan experiment of integrating the IRC activities of the
entire H5FW Sector and developing linkages with other sister
Departments for a coordinated IEC effort has been noted to be leading
to better achievements. . Other States/UTs may like to study this
experiment for possible replication.
2.11
I
Involvement of Non-Governmental Sector
For supplementing the efforts of the Government, it is necessary
to involve the non-Governmental organisations and voluntary agencies in
a very big way. Even though the need for this has been realised forquite some time with a view to make the Family Welfare Programme a
people’s movement, harsh reality is that so far the contribution from
the non-Governmental- Sector is rather limited and the programme is
perceived by the people as the Government's ’programme. Voluntary
sector and NGOs can not only supplement the family welfare services
provided by the Government but also it is expected that they would
have a better understanding of how to bridge the communication gap
gap
with the people and take the message of small family and Maternal and
Child Health to them in the language they understand.
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.11.1 Instead of waiting for a voluntary agency to approach the
■ over'7nient for assistance, it would be necessary to identify local level
individuals (youths in the villages, panchavat level leaders, private
medical practitioners including ISM practitioners, ex-servicemen, retired
ovt. servants with a social conscience etc.) to motivate them to
in"volS^Xm”
Pr°gramme- imPart training to them and
for the
/r lndlvldually or collectively for generation of demand
tor the family welfare services and propagation of small family norm.
2.11.2 The network of cooperative sector institutions
organised sector,
trade unions, Zill a Parishads, imunicipal corporations, panchayats, etc.
would be fully involved in the
the implementation
implementation of family welfare
programmes in a systematic manner.
2.11.3 Increased powers to sanction schemes
schemes for
for non-Governmental
w°Uld .?e delegated to the States/UTs which may further be
delegated to the
level1 with a view to expedite the sanction
- district
----------of
schemes and
also
because
and also because the actual work of identifying and
encouraging the. voluntary
workers at
root
necessarily
will
at c?grass
grass
rootu level,
level
•*
"*■
Xv/ v Uly
11 <3'
have to be done by -the district officers and other officers
of the State
Governments in this field.
In view of the fact that the
1 exceedingly good results.
State/Area. Further, -the available infrastructure would also be utilised
finpvoluntary sector workers to improve their administrative,
financial and managerial abilities.
2.11.5 In order to have the desired impact of the eliciting participation
of voluntary and N GOs, a suitable organisation would be evolved at
central level which will have the desired degree
of
of flexibility
flexibility in
sanctioning schemes and ensuring smooth flow of funds.
2.11.6 Increased allocations would be made L*
in the 3^
Central Budget for
implementation of Family Welfare Programmes through N GOs/voluntary
sector and receipt of -external assistance for this sector would be
considerably stepped up.
2.12 Inter Sectoral Coordination
One of the key points which always needs to be kept in view is
<
tthee distinction between the Family Welfare activities
and the population
control programme. Control of population is dependent on a variety of
j
actors, many of which go
beyond the sphere of the family welfare
sector, but which have an equal and perhaps even more important
earing on the birth rate. In fact, the Family Welfare Department in the
Centre and the Health a Family Welfare Departments in the State
Governments are organisations which should be essentially viewed as
Supply Departments for making available the family welfare services,
but the demand for these services and the motivation for population
control comes from factors such as female literacy rate, age at marriage
of girls, the status of women, position of employment of women, social
security and general level of economic development. These are well
beyond the pale of activities of Department of Family Welfare.
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2.12.1 There is need to have an institutional mechanism at the centre
for inter-sectoral coordination particularly between the Ministry of
Health 5 F.W., Ministries of Human Resources Development,, Finance,
Information 6 Broadcasting, Environment 8 Forests, Labour, Deptt. of
Woman 6 Child Development and the Deptt. of Rural Development, A.
suitable institutional mechanism would be evolved at the central level to
achieve the desired level of inter-sectoral coordination and ■ similar
mechanisms would be developed at the State level.
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2.12.2 At the State level, the Chief Secretaries would be involved
personally in making the Family Welfare Programme a success. At the
district level, Deputy Commissioners, Chief Executive Officers of the
ilia Parishads, would be involved in a greater way not to push the
target achievements in a routine manner but to achieve inter-sectoral
coordination of different Departments whose activities have a direct
bearing
J on family welfare programme performance.
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